1. Your name

2. Your company's name

3. Address:

Street:
City:
State:	Zip:

4. Phone:
()

5. Fax:
()

6. E-mail address:

7. Type of business:

8. Do you have a Web site now?
Yes No

If so, what is the address?
http://

9. How would you describe your level of Internet experience?
None Just getting started. Pretty good, but I'm no expert! Expert

10. Which of these phrases best describes what you want your site to do?

	Provide information about your company.
	Sell products.
	Expand your business by offering 24-hour-a-day contact.
	Reduce mailing costs by offering brochure or product information on-line.
	Provide customer support.
Other:

11. Which of these best describes your project?

	A good, basic, informational site; budget of $2,500 or less.
	A more sophisticated site that may include interactive features, such as a searchable database, an ability to update press releases or newsletters yourself, custom forms; budget of $4,000-$9,000.
	A state-of-the-art site that is a leader in the industry with specialized programming and design elements, such as catalogs, databases, video, password protection, custom CGI scripts, java or javascript programming; budget of $9,000+.

Other:

12. How would you describe your schedule for this project?
We're ready to get started right away. We'll probably be ready to start in a month or so. It could be up to 6 months before we start. We're just beginning research on this project.