Your Details
Company Name
Contact Name
Email Address
Website URL: (required)
Where is your current website hosted?
We pay for website hosting services directly (i.e. GoDaddy, SiteGround, etc.)
We pay another agency/contractor for website hosting services and maintenance
We don't have hosting yet, but have one in mind
We don't have hosting yet, but would like recommendations
Not sure
If you pay for your website hosting directly, please provide the hosting company and plan name
If you pay a third party for website hosting on a recurring basis, please provide the agency and plan name
Website admins
Where is your email managed?
Who is your email admin?
Your Website Goals
What do you want to accomplish with your website?
Who are your direct competitors?
Please list the names of three websites that you like and what do you like about them:
Does your company have target geographic locations? If so, please list them.
What actions do you want visitors to take on the site?
Website Requirements
Video (If yes, do you have videos on file or on your current site?)
Home page slideshow (if yes, please indicate number and specify if text will be included. If necessary, provide a sample website of something similar)
General contact form (if yes, please provide an example form you want to use)
Employment form (if yes, please provide an example form you want to use)
Newsletter signup form (if yes, please provide an example form you want to use)
Other (please be specific)
Do you have any color preferences, look and feel for the website?
Is there anything you do NOT want on your site in terms of text, content, color, or graphic elements?
Deadlines and Budget
Who will be the primary contact person for this project?
Contact email address
What is your deadline for completing the site?
1 – 3 Months (small projects only, i.e. logos or landing pages)
3 – 6 Months
6+ Months
What is your budget?
$2,000 – $5,000
$5,000 – $10,000
$10,000 +
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