Please describe what you would like to happen as a result of your or your business going online:

User Info

Please check which you use while on the Internet:
PC MAC Netscape Microsoft Explorer AOL Other

What is your favorite web site on the internet?

Who, if any, are your competitors on the Internet?

Have you had a website before? yes no

If yes, please explain:
Yes, our previous experience was...

Domain Info

Domain Type: .com .net .org .gov .edu .mil

Is your desired domain name (www.yourcompany.com) already registered?
yes no
If no, please list your desired domain name(s) (List at least 2 or 3 choices):

Site Info

Will you be selling online? yes no
If yes, what will you be selling?
If no, what will you offer?
Will you be offering online credit card processing? yes no
If yes, do you want 128 bit SSL encryption to secure your site? yes no

Number of images: 1-10 11-25 26-50 over 50
Type of images needed: scanned on disk custom
Total number of products or subjects:
Number of product catagories:
Approximate number of words:
Approximate number of pages:

Additional site features

Mail-to-Forms	Shopping Cart
Order Form	Custom Graphics
On-site hit counter	Password Protection
Adobe Acrobat Forms	Real-Audio
Macromedia Flash	Other

Maintenance account (periodic updates to your site):
None Weekly Monthly Quarterly
What type of maintenance will you need?

Additional comments:

When done, please or