Name

Company Name (if any):

How Long in Business?

Address

City

State

Zip

E-Mail Address

Phone Number

Do you have an existing Web Site?

Yes  No

If so, domain name:

If so, hosted through: 

Do you have existing E-Commerce?

Yes  No

If so, processed through:

Do you need E-commerce?

Yes  No

Do you have need a Database-driven website where users can create accounts for themselves & logins?

Yes  No

How many total pages do you need?

Please list Page Titles and functions of those pages:

Company Colors or Preferred Color Scheme?

Company Tag Line / Motto?

Existing Customer Logo?

Yes  No

If you don't have a logo yet, would you like a quote on logo design as well?    Yes  No

Deadline?

 Month:    Select Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec    Day:   Select 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31  Year:    Select 2008 2009 2010 2011 2012

Desired Web Site Title:

Site Description, (i.e., “The Best Laundromat in Seattle, providing coin-op washers & dryers”, etc.)

Keywords (words people will use to search for your services):

Do you have pictures you can  email to be included in the site?

Yes  No

Desired Menu Layout:

Horizontally across  Top  Bottom     - or -   Vertically across Left  Right

Desired Layout (pick one of five standard layouts – content is your body text.  The dashes and other info is where your menu would be.   White borders are page margins):

Additional Comments:

Thanks for taking the time to complete this questionnaire.  Based upon the information provided, we can get you an estimate back shortly.  Thanks again for considering IstariMedia LLC!