Website Design: Perception is Reality

* Name
Title
Company
* Email
* Daytime Phone
Evening Phone
Current URL (if there is an existing website)

* Type of Site	Business Site Personal Site Non-Profit/Charity Site Other
* Design Service Needed	New Website Design (from Template) New Website Design (Custom) Existing Website Re-Design Banner Design Other
* Estimated Number of Pages	5 or less 5 - 10 10 - 25 Not Applicable
* Estimated Budget	$1000 or less $1000 - $2500 $2500 - $5000 $5000 or more

		Page will include:
Page Name/Description (list pages and/or sections to be included in your site, along with a brief description of what the page is about as in the examples below) Check/uncheck to show or hide examples		Text	Images	Links	PayPal Buttons	Contact / Feedback Form	Location Map / Driving Directions	Audio / Video	File Directory	Password Protected Area
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2.
3.
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5.

Other Sections/Features Required	Calendar Setup Content Management (eg, SitePro WYSIWYG editor, Mambo, post-Nuke, etc) E-Commerce (Full store, multi-department) Forum/Message Board Setup Mailing List Setup Photo Gallery Setup Search Engine Optimization Other (please detail below)
* How Did You Hear About Us?	Google Yahoo Talking Phone Book Verizon Phone Book Word of Mouth / Current Client Other:
Additional Comments/Information
* Required Fields