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Want a website?

How did you hear about us?

If other/referral, please specify

How can we contact you?

Your name *

Company name

City

State *

Phone

Email *

Where you're at:

Do you have a domain name? * Yes No

If so, what is your domain name?

If no, what are some ideas you may have? (e.g. mydomain.com)

Do you have a website? * Yes No

If so where is it hosted? (include web address)

If you already have a site what are your plans for it? Overhaul Minor changes

What you're looking for:

How would you classify the website you want? * Informational
Selling products online
Both

What is the purpose of your site? The short and long term goals?

When is your intended launch date?

About the money...

What\'s your budget? *

Who are you trying to reach?

Knowing a little about the demographic of your target audience will help us in designing your website.

What is the age range of your target audience? (check all that apply) 14 and under
15-24 years
25-34 years
35-44 years
45-54 years
55-64 years
65+ years

Target gender Male Female Both

Time to make some sales.

Will you be selling products online? Yes No

Do you already have a shopping cart? Yes No

If so will you need modifications to your cart? Yes No

Approximately how many items will you be selling?

If you need a shopping cart please answer to the best of your ability.

Do you already have a Merchant Account? Yes No

If yes who with?

How would you like to receive payment? (check all that apply) Visa
Mastercard
Amex
Discover
Paypal
Check
Money Order

Anything we missed?

Additional comments: