1- Contact Information
Full Name *
Business Name *
Contact e-mail *
Address 1
Address 2
City
State
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
D.C.
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Zip Code
Country
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua & Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Azores
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire
Bosnia & Herzegovina
Botswana
Brazil
British Indian Ocean Ter
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Canary Islands
Cape Verde
Cayman Islands
Central African Republic
Chad
Channel Islands
Chile
China
Christmas Island
Cocos Island
Columbia
Comoros
Congo
Cook Islands
Costa Rica
Cote D'Ivoire
Croatia
Cuba
Curacao
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
East Timor
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Ter
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Great Britain
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guinea
Guyana
Haiti
Hawaii
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Kiribati
Korea North
Korea South
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Midway Islands
Moldova
Monaco
Mongolia
Montserrat
Morocco
Mozambique
Myanmar
Nambia
Nauru
Nepal
Netherland Antilles
Netherlands
Nevis
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Norway
Oman
Pakistan
Palau Island
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Island
Poland
Portugal
Puerto Rico
Qatar
Reunion
Romania
Russia
Rwanda
Saipan
Samoa
Samoa American
San Marino
Sao Tome & Principe
Saudi Arabia
Senegal
Serbia & Montenegro
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
Spain
Sri Lanka
St Barthelemy
St Eustatius
St Helena
St Kitts-Nevis
St Lucia
St Maarten
St Pierre & Miquelon
St Vincent & Grenadines
Sudan
Suriname
Swaziland
Sweden
Switzerland
Syria
Tahiti
Taiwan
Tajikistan
Tanzania
Thailand
Togo
Tokelau
Tonga
Trinidad & Tobago
Tunisia
Turkey
Turkmenistan
Turks & Caicos Is
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States of America
Uruguay
Uzbekistan
Vanuatu
Vatican City State
Venezuela
Vietnam
Virgin Islands (Brit)
Virgin Islands (USA)
Wake Island
Wallis & Futana Is
Yemen
Zaire
Zambia
Zimbabwe
Telephone *
Fax
How do you prefer us to contact you?
By e-mail
By Telephone
By Fax
By Postal Mail
2- Website Information
Does your business already have a website?
Yes
No
If yes, your business website domain name:
Your hosting company url (available or considered):
Your Hosting Package (available or considered)
3- Pre-design information
If no domain name available, would you like us to register a new domain name for you?
Yes
No
I don't Know
If Yes: Preferred Domain Name 1
Preferred Domain Name 2
Preferred Domain Name 3
Do you need hosting?
Yes
No
I don't Know
Do you have a business logo?
Yes
No
If business logo available, what colors does your logo contain?
4- Web Design Information
Other than e-commerce functionality, what kind of functionality and/or purpose will your site serve?
What kind of clients is your website targeting? Example: businesses, end users, webmasters, techs....
List one or more websites that you like or think are similar to your future business website?
In one sentence how would you describe your future business ecommerce web site?
What are your favorite 3 colors?
Other comments and notes to put in consideration for your custom web design: Specify any information you think will help give you the perfect web design.
5- Product information
What type of products are you planning to sell on your website? Example: Software, Furniture.....etc *
On average, how many products and categories do you expect to have in your database?Example: 100 products, 15 categories, 8prodycts/category
On average, how many attributes do your products have?What are these attributes?Example: weight, size, color....Enter all that applies
Will you require categories and subcategories (Multi-level Categories)
Yes
No
I don't Know
Do you want us to provide database entry?
Yes
No
I don't Know
If yes, how many products on average?
Do you need import-export functionality?
Yes
No
I don't Know
If yes, what format? example: exl,mdb...
6- Payment Information
What kind of payments do you want to accept on your website?Enter all that applies. Example: credit cards, COD, checks....
Do you need us to provide payment gateway or merchant solution?
Yes
No
I don't Know
7- Budget and Time
What is your budget for this project?
This project must be done before?
One Month
Two Month
Three Month
Six Month
Not Decided
8- Post Web Design Information (optional)
Would you like us to maintain your web site after development?
Yes
No
I don't Know
Would you like any services such as: search engine optimizations, search engine submissions, advertisement....explain
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