I. CLIENT CONTACT INFORMATION
|
| Client Name: * |
|
| Email Address: * |
|
| Company/Organization: * |
|
| Address: * |
|
| City: * |
|
| State: |
|
| Zip: * |
|
| Country: * |
Warning: mysql_select_db() [function.mysql-select-db]: Can't connect to local MySQL server through socket '/var/lib/mysql/mysql.sock' (2) in /home/content/14/5809414/html/_mysites/tblmedia/webdesignrequest_form.php on line 411
Warning: mysql_select_db() [function.mysql-select-db]: A link to the server could not be established in /home/content/14/5809414/html/_mysites/tblmedia/webdesignrequest_form.php on line 411
Warning: mysql_query() [function.mysql-query]: Can't connect to local MySQL server through socket '/var/lib/mysql/mysql.sock' (2) in /home/content/14/5809414/html/_mysites/tblmedia/webdesignrequest_form.php on line 413
Warning: mysql_query() [function.mysql-query]: A link to the server could not be established in /home/content/14/5809414/html/_mysites/tblmedia/webdesignrequest_form.php on line 413
|
| Phone: * |
|
| Alternate Phone: |
|
| Fax: |
|
| Current Domain Name (if any): |
|
II. WEB SITE PLANNING AND DESIGN
|
1. Service Request: (Please check all that apply)
New Website Design
- If this is a new website, will you need TBL Media to register your domain name? Yes
No
or
Website Re-Design
- If Re-Design and/or Maintenance and/or Update, please provide your URL: http://
|
| 2. Do you have a logo that you would like us to include in your website? Yes No
|
3. Do you have a company/product slogan? Yes No
If Yes, please describe
|
4. Website design for:
Personal Use
Company/Organization
|
5. What are the goals of your website? (Please check all that apply)
Establish on-line presence
Provide information
Provide customer service
Other (please describe):
|
6. The site will be (check ONE only):
100% HTML
Somewhat interactive website (1-2 forms)
Interactive/Dynamic (website served by a database)
|
7. Technology Preference: (Please check all that apply)
HTML
ASP
PHP
CFM
ASP.NET
MS SQL
MY SQL
Flash Introduction
Site ENTIRELY in Flash
Other
|
8. Web Site Contents (text, images, etc.):
Ready
To be developed
|
9. Which materials will you supply to us? (Please check all that apply)
Copy / text
Images / graphics
Audio
Video / animation
Layout
Site map
|
10. Which materials will you need help designing or creating? (Please check all that apply)
Copy / text
Images / graphics
Audio
Video / animation
Layout
Site map
Not sure / need help
|
| 11. Who is your Internet Service Provider (ISP)?
|
12. What information will be on your site? (Please check all that apply)
About Us
Jobs/Employment/Career
Products/Services
Pricing
Management Team
Image/Picture Gallery
Contact Us
Disclaimer
Site Map
Financials Reports
FAQs
Other:
Feedback
|
13. List your closest competitors, if possible, list the best examples of their websites, or sites that have the design and features you're looking for. Please list the URLs (website addresses).
a.
b.
c.
|
14. Web Hosting Required?
Yes
No
Please list your current hosting company
|
| 15. Number of Email Accounts (POP3) required
|
| 16. Font requirements:
|
17. Background color requirements, or the background color you'd prefer (such as organization identity color):
Color Type
|
18. Additional Services:
Banner Ad Designing
Photography
Scanning/Imaging
Data-Entry
Copywriting
Training
|
19. User Interactivity: Additional
components/features integrating in your web site (please
check all that apply):
Shopping Cart System
Online Payment System
SSL (Secure Sockets Layer) Certificate
Searchable web catalogue
Multiple Domains point to the same site
Picture / Image Gallery
Forum
Banner Exchange
Chat Window
Polls and Voting
Random Quote Display
Content Management
Web-based E-mail
Clock
Website Statistics
Calendar
Banner Ads
Calculators
Newsletter
Classifieds
Member's-only Access
Live Counters
Search Engine Optimization
Website submission to Search Engines
Others (please describe):
|
20. Email Forwarding:
Yes
No
If Yes, please provide the forwarding E-mail address:
|
21. Maintenance:
1 year
2 years
Other:
|
22. Estimated Maintenance:
Number of pages to be updated
Number of new pages to be added
|
23. Will you need training to utilize the website? (website administration training, etc.):
Yes
No
|
|
|
