Personal Information
First Name
Last Name
Name of Organization
Email Address
Phone Number Cell Phone  

Questionnaire
1. Do you have a web site?  Yes  No
  a. If so, do you have any interest in an affordable redesign?  Yes  No
  b. Please submit the URL of your web site. 
2. If you don’t already have a web site, select one of the following:
   a. A customized template package ($999)
   b. An original web site design (starting at $1499)
3. Please submit one or two URL’s of web sites you like, from your own profession: 
  a. b.
4. Please submit one or two URL’s of any other web sites you like: 
  a. b.
5. Do you have a logo?  Yes  No
  a. If not, are you interested in logo development ($599 to $999)?  Yes  No
6. Do you plan to update your web site once every two months or more?  Yes  No
7. How many people will you have updating the web site?
8. Please choose which update option you favor:
   a. Paying someone to update your web site ($75 per hour)
   b. Updating your web site yourself using our easy-to-use maintenance software ($29 per month)
9. Are you interested in any of the following design add-on’s? (select any that apply)
    a. Basic Image Package A ($99)
   b. Premium Image Package A ($199)
   c. Flash Animation (starting at $499)
   d. Logo Design (starting at $599)
10. Are you interested in any of the following web site add-on’s? (select any that apply)
   a. Site Search ($99)
   b. Custom Forms (starting at $99)
   c. PayPal (starting at $299)
   d. Newsletter ($399)
   e. Blog Software ($499)
   f. Polling Software ($599)
   g. E-commerce / Online Sales (starting at $599)
11. Are you interested in any of the following web site services? (select any that apply)
   a. Web Site Marketing ($75 per hour)
   b. Copywriting and Copyediting services ($39 per hour)
   c. Content Conversion ($29 per hour)
12. Have you already purchased a URL?   Yes  No
  a. If yes, what is it?
  b. If no, please suggest a URL you would like. 
13. Do you plan on using our hosting services? ($19.95 per month)   Yes  No
14. Do you need email?  Yes  No
  a. If yes, how many accounts?