Name
*
First Name
Last Name
E-mail
*
Phone Number
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Area Code
Phone Number
Company
Type of Business
Please Select
Accomodation / Hotels
Advertising
Aerospace, defence & security
Asset management
Automotive
Banking & capital markets
Communications
Creative Arts & Media
E-Commerce
Energy, utilities & mining
Engineering & construction
Entertainment & media
Financial services
Food
Forest, paper & packaging
Government and public services
Healthcare
Hospitality & leisure
Industrial manufacturing
Insurance
Manufacturing
Marketing
Mining
Music / Radio
Pharmaceuticals & life sciences
Retail & consumer
Restaurant
Technology
Telecommunications
Transportation & logistics
Travel & Leisure
TV / Film
Wholesale
Web based industries
Other
If industry is other, please explain
Type of Website You Need?
Please Select
Personal
Educational
Blog
Sport
Food, Restaurant
Local Business
Small Business
Medium Business
Choose Items for the Navigation Bar
About
FAQ
User Guide
Forum
Blog
Pricing
More Items
Additional Services
Logo Design
Banner Design
Photography
Graphic Design
Content Management
Landing Page Design
Advertisement Management
Learning Management System
Live Chat
SEO
Video
Analytics
Other
Do you currently have a website? If so, what's the address?
Do you have a domain name registered?
Yes
No
If yes, what is the Domain Name?
Do you currently have a logo or corporate colors? If so, please upload.
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What is the website's main purpose?
To sell products
To promote services
To collect email addresses
To build a brand / community
Other
Do you want any of the following? (There is space at the end of the form for other requirements).
Blog
Social sharing icons
Links to social profiles
Contact form
Email signup form / ability to collect email addresses
Ability to sell digital products
Other
How many pages will the website have roughly?
1-5
5-10
10-25
25-50
50+
What is your budget?
$500 - $1500
$1500 - $3000
$3000 - $5000
$5000 +
I'm not sure
rather not say
Ideally, when would you like the website completed?
-
Month
-
Day
Year
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Please list two or three websites you admire or would like to emulate:
Further Comments
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