Web Design Request Form

Web Design Request Form

This request form will help us put together a solution that best reflects you or your small business. The information you provide will determine how much work needs to be done and will save you time and money by helping identify your specific project requirements. Please fill in as detailed as possible. If you have social media pages or links that can provide information, please enter links into text box.
Contact Information
Your name (required)

First NameLast Name
E-mail Address(required)
Phone number(required)

Area CodePhone Number
Company/Brand Background
What industry?
What is the name of your company/brand? (required)
Tag/line motto to be features on home page
Who is your target audience?
What is the intent of the website?
What is the purpose of your website (check all that apply)
Do you have a logo or branded materials such as business cards, stationary?
Upload logo/branding material here:

Upload File(s)

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Website Content Requirements
Will you be replacing existing website?
What is the full domain name? (i.e. www.mysite.org)
What do you currently use to host your website?
Do you need hosting AND email?
What is the intended website address? (i.e. www.yournewsite.com)
What content pages are needed for your website (check all that apply)?

Other
Do you have a color scheme? If not, what is your color preference?
insert link to inspirations
COLOR THEME: Upload pictures, videos, screenshots etc.for reference.

Upload file(s)

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What design aesthetic would you like to portray with your new site?
What kinds of images best reflect your business? Upload inspiring images/screenshots for reference.

Upload File(s)

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Input text for HOME PAGE:
Upload content for HOME PAGE:

Upload File(s)

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Input text for BIO/ABOUT:
If text is included in uploaded file, input "ref"
Upload content for BIO/ABOUT:

Upload File(s)

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Input text for GALLERY/PORTFOLIO:
If text is included in uploaded file, input "ref"
Upload content for GALLERY/PORFOLIO?

Upload File(s)

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Upload PRODUCT images for e-commerce?

Upload File(s)

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Contact Forms

Information intended for the contact page for public access.
E-mail Address(required)
example@example.com
Phone number(required)

Area CodePhone Number
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
social media accounts
Set up + Maintenance Needs
How important is Search Engine Optimization for your website?
Will you need a Content Management assistance to be able to maintain and add content to your website without (or with little) external help?
Please list your competitors' websites. What do you like and about their websites?
Are there any specific detail you would like incorporated into your website? Why?
copy/ paste website URLs
Additional comments
Enter the message as it's shown
Should be Empty:

Web Design Request Form

Contact Information

Company/Brand Background

Website Content Requirements

Contact Forms

Set up + Maintenance Needs