1. Name
2. E-mail
3. Telephone
4. Title
5. Company
6. Address  line 1
7. Address  line 2
8. City
9. State
10. Post Code
     
11. What products and services do you offer, sell or supply?
 
   
12. Do you already have a website?
  Yes No
   
13. Enter Your Domain Name, If you have one
 
   
14. What pages would you like to include on this website?
   
 
   
15. What other additional features and functionalities would you like to include?
 
Flash Animation Custom Driving Map Content Management
Audio Streaming Video Stream Site Map
Inform-a-Friend Password Protected
Flash Intro
   
16. Do you need an online store (shopping cart) to sell products / services on-line?
  Yes No
   
  a. About how many different products will you sell on-line? 
  b. How do you want to process credit card transactions? Manual  Automatic
   
17. Will your site require an online database?
  Yes No
  If yes, explain the function of this database.
 
   
20. List 3 sites that you really like the look and feel, so we can have a better understanding of what you are looking for:
 
 
 
   
21. List 3 of the top competitor sites:
 
 
 
   
22.
How soon do you need this project completed? 14 Days
21 Days
28 Days or more
   
23.
Will you provide us with all the text for the website?  Yes  No
24.
Will you provide any imagery for your web site? Yes  No
25.
Will you need a logo developed? Yes  No
26.
Will you need professional photography services? Yes  No
   
27.
Budgetary constraints ($):
   
29. Please enter any additional information you would like considered in the preparation of your price quote.
 
   
30. How did you hear about 200 Pixels?
 
Google Yahoo
Newspaper Other Search Engine
Flyer Referred by Friend