Web Builder USA

Personal / Business contact information:

Name
Title
Organization
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Country
Work Phone
Home Phone
FAX
E-mail

Do you currently have a website ?

Yes No

Website URL Address:  

Current Web Host:         

Check here for information on other hosting options, and list preferred Domain Names below:

            First Choice:       

            Second Choice:  

            Third Choice:      

Will this be a business or personal site ?

Personal Business

A brief description of your business:

Who will be your target audience ?

What gives your company its competitive edge ?

Who are your competitors ? List their web addresses if known:

What would you like the site to achieve?

What types of options are you interested in ?

Home Page about you or your company.
Services and Products.
Promotions, Events, Contests, New info.
Specials, Discounts.
Site Search Engine.
Privacy Policy.
Visitor Counter.
Forms - Feedback, Ordering, Surveys, Comments.
Reservations.
Links to other sites and information.
Online Store.

Any options or content not listed above:

What materials will you provide ?

Brochure           Annual Report             Logo /Images                     
Text               Business Card             Sketches   
Other Graphics     Other Printed Material    Photographs

Please describe other materials not listed above:

What is the allotted budget for the website ?

Any comments or questions that you might have: