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Purchase Order Survey

Use this form to help us determine how best to serve you. If you want us to build a Website, we need to know the type of Web site you want and the services you require.

Please answer as many questions as you can...

Note: You can reduce the cost of building the Website if you can provide Web ready graphics on disk. But do not worry, we can develop new graphics and artwork, or scan them in, for very competitive prices.

Your Name:

Company:

Your eMail:

Phone:

Fax:

Address 1:

Address 2:

City:

State:

Zip:

Who are you trying to reach

What do you want to accomplish? (please select all that apply)

	Attract new customers
	Provide information about our company
	Control the release of time sensitive information.
	Promote a favorable impression
	Improve overall customer service
	Encourage customers to contact us by eMail.
	List product information and prices
	Provide helpful information for our customers
	Address FAQ - Frequently Asked Questions.

List 3 websites you like

List 3 competitor websites

Art work, Graphics, Copy and Text (please select all that apply)

Company logo

Written Copy

Graphic Images

Photographs

We would like to consider the following package (please select all that apply)

	Bronze
	Silver
	Gold
	Platinum
	Diamond

List Elements you want on your site (please select all that apply)

	Password Protected Areas
	Order Forms
	Online "Shopping Cart"
	eCommerce / Credit card approval
	Sound and Audio files
	Animation (gif, Flash, Macromedia, etc.)
	Video clips (various file formats)
	Streaming audio and video
	Virtual reality
	Movies
	Database integration
	Guest books for visitors to record comments
	Shopping Catalog
Other

Which Internet browser do you use? (please select all that apply)

	Fire Fox
	Netscape
	MS Internet Explorer
	AOL
Other

Additional Services (please select all that apply)

	Website Maintenance
	Website Promotion
	Domain name registration
	Website Hosting
	Internet Access
	Graphic Scanning
	Web content development

Which screen resolution do you use? (please select all that apply)

Packages

	1600 X 1200
	1280 X 1024
	1152 X 864
	1024 X 768
	800 X 600

Enter your Registered Domain Name, otherwise list 3 options for the name you want.

First Choice or Registered Domain Name

Second Choice

Third Choice

Does this project have a deadline?

(If yes, please enter date)

COMMENTS

Information about a site that currently exists.Approximate size of site in Megabytes

Approximate transfer rate per month in Gigabytes

Number of Web Pages in the site

May God Bless the men
and women who fight to keep our country free.