Web Design Creation Request Form

JBC Web Design Request Form

Get Your Uniquely Designed Professional Website to Maximize Exposure to Your Target Market.
Sales Rep
Client's Information
Full Name

TitleFirst NameMiddle InitialLast Name
E-mail*
Phone Number*
Company*
Type of Business*
Company Address

Street Address

CityState / Province

Postal / Zip CodeCountry
Project Details
Geographic Market
Target Markets
Example: Doctors, Boutiques, Small Business Owners
Project Overview*
Give us an overview of what the project is going to entail.
Company Tagline
Give us your company tagline. (If applicable)
Project Scope (choose all that apply)*

Web DesignWeb DevelopmentSEOE-commercePortal Logins(Corporate, Affiliates, Customers)Content Retrieval(Videos and Documents)Online Course DevelopmentCustom WordPressBranding StrategyMarketing StrategySocial Media StrategyMarket/Audience GrowthOther
Do you have a current URL?
If yes, please provide.
What URL do you prefer?
If you do not currently have a URL.
Is this a Dynamic or Static Website?*

Dynamic: I would like to update the content myself and improve SEOStatic: I do not need to be able to update anything myself.Not relevant
How many pages do you need?*

Single PageUp to 5 (example: Home, About, Services, Contact, Gallery, etc.)Up to 10 (usually for a bigger website, like blog, or information heavy)Up to 20 (CMS website, with blog, multiple page levels, E-Commerce)Not relevant
Choose items for the navigation bar. (choose all that apply)*

AboutBlogContact UsFAQGalleryHomeServicesProductsOther
Do you already have a logo?

Browse Files
If yes, please attach it here. Cancelof
If none, please give us an idea of what you want your logo to look like.
Do you have a slogan that you would like to use?
This can be used to help you create a theme for your website.
What is your color preference? (Please click the lightgrey box.)*
If you have specific pantone or other color request, please specify.
Please select the font style that you would like to use.*
Tell us more about your business.*
Who is your target audience?*
Examples: Age, Industry, Gender, Income, Geographical Area, etc.
Do you have a Mission statement?
Please list your competitors' websites. What do you like and not like about their websites?
URL's - List any other websites that you find compelling. What do you find the most inetresting about these sites? (e.g. style, colors, layout, content, etc.)
Do you have images and content that you would like to include in your website?*

Browse Files
Please upload it here. As many as you want. Cancelof
Do you need hosting and email?*
If yes, please put your hosting and email below.
Hosting and Email
Please separate the two by a comma.
If you want to link your website into your social media accounts, please fill in the following:
Facebook
Twitter
Instagram
YouTube
Pinterest
LinkedIn
Do you need a Content Management System (CMS) to be able to maintain and add content to your website without (or with little) external help?
Comment section for the question above.
If you want to include a map on your website, please fill in the exact location of your company.
When do you want your website to be finished?*

2-3 weeks1 month1-2 months2-3 monthsOther
How much do you plan to invest in this project? (USD)*

$1k - 3K$4K - $6K$7K - $10K$11K - $15KOther
Current Website
With whom do you currently host your website?
Example: GoDaddy, HostGator, Bluehost, Justhost, iPage, SiteBuilder.com, etc.
Will the existing website content be used?
Comment section for the question above.
Note: We may need to obtain credentials to your existing website for some content such as database or other items.
Any additional comments
Should be Empty:

Client's Information

Project Details