WebCenter Website Hosting Application Survey

What is your full name? *
What is your title or position with the company?
What is the Business or Organization Name?
Business Street Address
What is your City, State, and Zip Code? *
Email Address: *
Business Phone
Business Fax
Home Phone
Cell Phone
Would mornings, afternoons, or evenings be the best time to follow back up with you by telephone?
Do you have a logo in ready-to-use (digital) form?	Yes No
Do you have a logo in a digital form - but it needs some editing/retouching?	Yes No
Do you have a drawing to develop a logo?	Yes No
Do you need a logo to be created from scratch for web only?	Yes No
Do you need a logo to be created from scratch for web and print?	Yes No
Do you not need a logo?	Yes No
Please indicate your approximate buget range to have a logo developed.
Briefly describe the nature of your existing business
Current Website (if available)
Do you have a site plan or outline?	Yes No
Have you created a site diagram?	Yes No
If yes, how many pages are in your site plan or site outline?
How many web pages do you feel your site will require?
If possible, please list the titles and topics of these pages.
If no, would you prefer that we make the layout reccomendations?	Yes No
Select from following choices - Is this a new website, re-design, or a basic makeover?
What type of website is needed - Personal, Business, Organization, Non - Profit or Other?
If you are representing a Non - Profit Group do you have current validation or verification of (501 - C3) status qualification?	Yes No
Indicate from the following the best purpose and goals for your website: Promote your business, provide information, share your interest, to sell products, to teach or educate, or other
What's your timeline for completion?
List the URLS of some sample websites that you might like
Use a few keywords to describe the overall impression you want your site to give your visitors.
Do you plan to write your own copy (text)?	Yes No
Have you written the text that will appear on your website?	Yes No
Please describe the content that you have prepared.
Is the content you have created in digital form?	Yes No
Do you want drawings/images/photos on your site?	Yes No
How many drawings/images/photos?
Will you be providing them as Original Documents, Prints, Transparencies, or Digital (files)?
Do you have the rights to use the drawings/images/photos?	Yes No
Do you need photos taken?	Yes No
Do you need graphics created?	Yes No
What sort of graphics do you need created, Animated Images, Mp3, Stills - jpg or gif, Flash, Quicktime, Diagrams, 2d Technical Drawings, 3D Models, or Other Graphic requirements?
On your page layouts web page header do you intend to use your current company logo, photo or drawing, or need it designed completly from scratch?
On your page layout web page footer do you want standard company ID? eg:
What trade or service marks does your company want to indicate in the footer bottom area?
Do you need Online order or feedback forms?	Yes No
If yes, how many?
Do you have physical hard-copy versions of these forms currently available?	Yes No
Do you have digital versions?	Yes No
Must any of these forms use a secure server (ie, must they be encrypted)?	Yes No
How many people must receive the contact information submitted?
Do you require a calculator, validation or other iteractive elements in your forms?	Yes No
If yes, please describe briefly about the forms:
are there any other form processing requirements?	Yes No
Will you need a password protected areas	Yes No
If yes, please describe briefly here:
Will users of your website need to download files?	Yes No
If yes, please describe briefly here:
Do you have a registered Domain Name?	Yes No
If yes, what is the name? http://
If no, do you want eBizness Network Group to register a Domain Name for you?	Yes No
What is the desired Domain Name, and a few alternate choices?
If you are not interested in getting a Domain Name, do you want to get a Sub- Domain Name (like yourname.hostname.com)?	Yes No
Do you need someone to host your website for you?	Yes No
If yes, what price range are you interested in: Basic, Business, Corporate, or Enterprise?
You can have a number of email addresses attached to your new site. How many will you require?
Do you want eBizness Network Group to maintain and/or make updates to your website?	Yes No
How often would your website require maintenance, on a daily, weekly, monthly, quarterly basis?
Please briefly describe the nature of the updates your site would require?
What your target groups do you identify with: Children to 12 yrs, Young People, Adults, Older People, Female, Male, People with the same: City, region, County, World, Industry, Interests, or Other:
Please briefly tell more about your target group:
Are you interested in a one-time submission to about 100 main search engines and directories?	Yes No
Do you want eBizness Network Group to submit your website to main search engines?	Yes No
Are you interested in regular re-submissions?	Yes No
Are there specific search engines and directories you are interested in?
Do you want eBizness Network Group to find suitable other search engines and directories for you?	Yes No
Do you want eBizness Network Group to help you promote your site through link excahnges, publishing a newsletter, or developing an eMerge mailing list?
What design services for advertising and off-line marketing do you need designed and/or printed: Business Cards, Letterhead & Envelopes, Ads for a Newspaper or Magazine, Illustrations/Diagrams, or Settings for Displays or Commercials.
Are you interested in having a CD of your website for distribution?	Yes No
If yes, what else might you include: Music tracks, Video & Audio, Video Only, High Resolution Images? Photographs, Existing Documents/Manuals, or Other.
If other, please describe detailsof other inclusions:
How many copies of the CD (less than 5, 6 - 20, 21 - 50, or more than 50)?
Do you want PDF files from your website or CD?	Yes No
If yes, what sort of content (Text, Drawings/Line Art, Photgraphs or Images - grayscale, Photographs or Images - colour, A4, or Larger than A4, or Other.
If other, please describe in more details:
How many pages on your website? Example: less than 5 -9, 10-19, 20 -29, 30 - 49, 50 -59, 60 - 99, or more than 100 - 149 pages:
Please list the individual, and/or the sales agent's full name that referred you to us if applicable, or indicate how you found us Online. Thanks in advance for your cooperation and your Online business support! *

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