First:   Mid:  Last:
Company Name
Street address
Your City
State/Province
Zip/Postal code
Country
Work Phone	FAX
Your E-mail
Type of Site you want: (We do not handle pornographic, occult or hate sites) Business Church or Para-Church Organization Consultant  Home-based Business  Internet Retail Licensed Professional  Links Site Non-Profit Organization  Personal or family site  School  On-Line Retail Shop
Type of Design plans you want: Business Card Site  Services Site   Product Site Non-Profit Site     Site Redesign

How many pages are in or do want in your website?
Do you want to add any of the following pages to your plans? (We will include them in our final estimate) Awards page   Chat/ Online Forum   Contact Form Disclaimer   Discussion Group FAQ   Feedback   Foreign language order form with currency converter   Mail/phone Order Form    News Release  On-line Newsletter  Outside Links   Privacy Policy Extra Product/service detail pages   How many?
Will you provide us with: text from a brochure  Animated Graphics  Music  Logo   Product photos  I would prefer that you write our text for us
What domain name you want to use?
Domain detail: registered  unregistered  please transfer my domain Host details: I need a new web host:   use the same host   transfer my domain

Do you agree to reimburse us for the cost of registering your new domain name(s)?  Yes   No

Desired completion date:
What is/are your products or services?
How many products/services do you sell?
To whom are you selling your products or services (your target market)?	Business   Children    Men    Women    Teens/Young Adults    Trade or Professional Other
Which keywords would you use if you were searching for your services or product at Yahoo? (10 maximum)
Describe the new "tone" you want for your new site. Select One:	Professional and business-like   Sporty For Kids Elegant, warm and friendly   Christian/spiritual   Consumer/Help oriented  Country casual Other   Please describe
If you want to change the colors you are using now, what colors do you prefer for your site background, text, links?	Please select for me   I have my own background image   Background:  Text:  Links:     Hover:
How do you access the Internet?	Dial up modem 28.8/33.6     Dial up 56K modem ISDN    DSL/ADSL     Cable modem    Web TV

How did you find our web site?
If you used a search engine, which one?
What keywords did you use?

Comments:

MasterCard	Visa	Discover	Am Ex	Check	Wire Transfer*
Signature: ____________________________________			Exp. Date: ____________		Deposit Amt: ____________

* International customers: Please call us to arrange your Western Union or bank to bank transfer. 

Thanks for trusting us with your web site design needs.