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WEBWORX DESIGN CO. OFFERS PRSFESSIONAL WEBSITE DESIGN FOR SMALL BUSINESS' AND INDIVIDUALS.

You may fill this form in and fax it to us at 516-735-2953 or Cick the Submit Button at the bottom of this page Or, please give us a call toll free at 1-877-782-6255 for a Free Phone Consultation/Price Quote.

Please answer as many of these questions that you can or just send use the box at the bottom to describe your needs. This list is just something to help us determine what the estimate for services will be.

Your Name

Your Email Address required field

Is this for a NEW website design or for a "Update" of an existing website. New Update

If this is for a NEW website design, will you be wanting your own domain name? (eg: www.yoursite.com)

Domain Name :
Choice 1
Choice 2
Choice 3
Do you have your "Domain Name" registered already? Yes No

If you have your own domain name what is it?

Will you need a shopping cart? Yes No

Do you have a Merchant account for taking credit cards? Yes No

If you need a shopping cart how many products do you have?(approx)

What is the subject of your web site?

What type of "Image" are you wanting your website to convey? Please select one:

If other describe here:

What is your budget for this project?
We will take the time necessary to work with you to establish a budget that meets your needs.

What type of information will you want to include in your website?
Here are some examples:
Check all the apply: * = recommended

1 Home/Introduction Page*
2 Service Information Page/Pages*
3 About you/your Company*
4 Product Information Page/Pages*
5 "Printable" Order Form Page*
6 "Online" Order Form Page*
7 Shopping Cart w/ secure server ability Pages
8 "Online" Survey Form
9 Guest book Installation
10 "What's New" Page of Your Website Updates and Announcements
11 "FAQ's" Page for Your Viewers*
12 "Online" Newsletter Page
13 Tips, Hints or Useful Information Page/Pages
14 Contest Page/Pages
15 Links to Related Businesses Page
16 Awards You've Won Page
17 Contact Details Page*
18 Comments Form Page for viewers to send their comments to you.*
19 Auto responder to answer e-mail automatically.

We provide email accounts with our hosting at no extra charge.

Do you need email accounts eg. yourmail@yoursite.com yes

How many email accounts will you need?

Other : Please describe:

Who is your "target" audience?

What "keywords" would describe your website? (list up to 20 & use commas)

Will you need space on the Internet to "host" your website?
Yes No

Will you want custom graphics for your website?
Yes No

Will you want "animated" graphics?
Yes No

Will you need a logo and banner design?
Yes No

Will you need someone to "update" your website periodically?
Yes No
If yes, will you need the updates: Daily Weekly Monthly

EXTRAS: We submit your site to the top search engines . Will you want "extra" promotion done for your website, ( "submission to other search engines", "submitted to announcement sites")
Yes No

If you would prefer just to describe your needs or
if there is anything additional please use this area to comment on those:

Thank you for your inquiry! We will contact you through the e-mail address you provided above shortly. If you have trouble with this form, please contact us at sales@webworxlive.com