No one enjoys filling out forms, but for your project to be successful I need some information about your website.
Company Name
Your Full Name
E-mail
Phone Number
Country — Afghanistan Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Arctic Ocean Aruba Ashmore and Cartier Islands Atlantic Ocean Australia Austria Azerbaijan Bahamas Bahrain Baker Island Bangladesh Barbados Bassas da India Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Bouvet Island Brazil British Virgin Islands Brunei Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Clipperton Island Cocos Islands Colombia Comoros Cook Islands Coral Sea Islands Costa Rica Cote d'Ivoire Croatia Cuba Cyprus Czech Republic Denmark Democratic Republic of the Congo Djibouti Dominica Dominican Republic East Timor Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Europa Island Falkland Islands (Islas Malvinas) Faroe Islands Fiji Finland France French Guiana French Polynesia French Southern and Antarctic Lands Gabon Gambia Gaza Strip Georgia Germany Ghana Gibraltar Glorioso Islands Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Heard Island and McDonald Islands Honduras Hong Kong Howland Island Hungary Iceland India Indian Ocean Indonesia Iran Iraq Ireland Isle of Man Israel Italy Jamaica Jan Mayen Japan Jarvis Island Jersey Johnston Atoll Jordan Juan de Nova Island Kazakhstan Kenya Kingman Reef Kiribati Kerguelen Archipelago Kosovo 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 Micronesia Midway Islands Moldova Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Navassa Island Nepal Netherlands Netherlands Antilles New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island North Korea North Sea Northern Mariana Islands Norway Oman Pacific Ocean Pakistan Palau Palmyra Atoll Panama Papua New Guinea Paracel Islands Paraguay Peru Philippines Pitcairn Islands Poland Portugal Puerto Rico Qatar Reunion Republic of the Congo Romania Russia Rwanda Saint Helena Saint Kitts and Nevis Saint Lucia Saint Pierre and Miquelon Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia and the South Sandwich Islands South Korea Spain Spratly Islands Sri Lanka Sudan Suriname Svalbard Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Togo Tokelau Tonga Trinidad and Tobago Tromelin Island Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom USA Uruguay Uzbekistan Vanuatu Venezuela Viet Nam Virgin Islands Wake Island Wallis and Futuna West Bank Western Sahara Yemen Yugoslavia Zambia Zimbabwe
Optional Skype Username
Launch date
Is your launch date fixed or flexible? — fixed flexible
Site desired — Brand new Site Re-design of an existing website Maintenance or upgrade Template Design only Other, contact me.
Project Budget — 1000$ – 1499$ 1500$ – 1999$ 2000$ – 2999$ 3000$ – 4999$ 5000$ – 9999$ 10.000$ – 14.999$ +15.000$ Other.Please,contactme.
Describe briefly your dream website (e.g. Number of columns, color…)
What is the primary purpose of the site? (e.g. To make a sell, to make an inquiry, to show your portfolio…)
How many pages are required? Could you list them all? e.g. Home, About, Portfolio, Contact…
What features do you want on your website? E-commerce(ShoppingCart) ContentManagementSystem(CMS) Weblog(Blog) ImageGallery Polls UserForum DetailedStatistic SearchFunctionality NewsletterManagement EventCalendar None Other,contactme.
If E-commerce, how many products will you sell? — Lessthan50products 50to100products Morethan100products Don'tknowyet
Will you be providing any of the following content or materials? No – We need help with every aspect of our site No – But you can use existing Brochures/Literatures to write the content Yes – We will provide copy/text for our site Yes – We will provide images/graphics Yes – We will provide the Logo of our company Yes – We will provide video/music Yes – We will provide other kind of media/files Not Applicable Other – Please, contact me
URL of Web sites you like (e.g. http://site.com)
Competitors URL (e.g. http://competitor.com)
Additional Comments
Current Web site URL (if applicable) .
Domain Information — Need to Register a Domain Already have a domain Don't know, contact me Not Appicable
Website Hosting Information — Need help me to find a host Already have a Host Don't know, contact me Not Applicable
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