W LUXER TECHNOLOGIES
WEBSITE DEVELOPMENT INTAKE FORM
Your Information:
Client Name
*
First Name
Last Name
Best Phone Number to Contact
Please enter the best phone number to get in contact with you
Format: (000) 000-0000.
Best Email to Contact
Please enter the best email to get in contact with you
Your Business Information
Business Name
What is the name of your business?
Business Slogan/ Catch Phrase (Optional)
Business Address (Optional)
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Business Phone # (Optional)
Format: (000) 000-0000.
Business Email (Optional)
example@example.com
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Business Brand/Mission Statement
Briefly describe your business (the brand or mission statement). (1 paragraph)
Services
What services does your business offer?
Provide a full list (if any) of services that your business provides, followed by a brief one sentence description of each service.
Example: (Professional development- Enhance skills and knowledge to help both individuals and organizations stay competitive.)
Operating Business Hours
List the operating hours of your business below
Business Awards/ Certifications (Optional)
List any certifications and/or distinguishing awards that you or you business holds that you would like to add to your site.
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Your Website Features
Select the features that you would like to have on your website
Rows
Would Like
Live Chat
Schedule/Book Appointments
Blog
Online Store/Purchasing
Other
If 'Other' was selected, please describe the feature you would want to include.
Website Design Examples That You Like
Please list at least 1-3 websites that you like as far as their design that may be something you want to go for. (Design, animation, styling, content, etc.)
Rows
Link to Website
What you like about this site
Website Example 1
Website Example 2
Website Example 3
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Social Media Links (Optional)
Fill this section out only if you have any social media links for your business
Select any social media accounts that you have for your business and their appropriate links.
Rows
Have
Link
Facebook
Twitter (X)
Instagram
LinkedIn
Pinterest
Other
Site Pictures/ Media
Upload any attachments related to your business that you would like to see displayed on your website(ie. Logos, Designs, Staff Photos).
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Propose a Time to Discuss Further
Propose an Appointment Time
Submit
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