General Information

Type of Web Site: Personal Commercial E-Commerce

Customer Type:

Special items wanted on Site:

Which type of design do you want?:

Simple (Little or no graphics) Complex (Flash animations/Graphic intensive)

Do you want Java applications added to site?: Yes No

Type of Images used: Thumbs Animations Jpg Gif Png Pictures

Advanced Animations: Flash

Have your own graphics?: Yes No

Would you like us to provide graphics for your site?: Yes No

If yes then what type?: Logo Banner Graphics

Links available to user: (Please list sites available to user)

Do you have email accounts for site?: Yes No

Would you like them available for customers?: Yes No

Do you have company email accounts?: Yes No

Would you like users to contact the above accounts?: Yes No

Do you have a database available?: Yes No

Will you need Forms created for site?: Yes No

Additional Information

Contact Information

First Name: Last Name:

Company Name:

Address 1:

Address 2:

City: State: Zip code:

Email Address:

Phone Number: ( ) - Ext:

Would you like us to contact you?: Yes No