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1. Client Type: Individual Sole Proprietor
Partnership Corporation LLC
Assoc/Club Non Profit Corporation  
2. Referred By:
3. Organization:
Contact Person: Daytime Phone:

Cell Phone: E-Mail:

4. Mailing Address:

City: State: Zip:

 
5. Website Purpose: Personal Brochure e-Commerce
Nonprofit Fundraising  
6. Domain Name:
7. Do you have a Domain Name registered? Yes No
8. If Yes, www.
9. If No, what names would you like to register,
based on availability and in order of preference:
www.
www.
www.
www.
.com .net .org
Web Hosting:
10. Have you purchased Web-hosting for your website? Yes No
11. If yes,what is the name of your Web-host?

12. If yes, what are the terms of your agreement?

Monthly Quarterly Annual
$ $ $
13. Available Space (MB)
14. Monthly Bandwidth
15. Password Protected Folders? Yes No
16. Other Features
17. If you have no Web-host, what is your preferred budget?
Monthly $ Quarterly $ Annual $
e-Commerce Requirements:
18. What are you offering for sale? Merchandise Services
19. Number of items: Price Range:
20. Do you have a business checking account? Yes No
21. Name of Bank:

22. Do you have a Merchant Account that accepts credit cards?
Yes No
23. Name of your Merchant Account Provider?
24. Does your Merchant Account Provider offer services for
secure Online Transactions? Yes No
25. Is your business registered with PayPal for online
credit card and check transactions? Yes No
26. Is your business registered with c2it for online
credit card and check transactions? Yes No
Website Requirements:
27. Do you have a special Logo or Graphic to be included
on your website? Yes No
28. Do you have photos to be included on your website?
Yes No
29. Are your photos digitized? Yes No
30. Do you need Digital Photography services? Yes No
31. How many pages do you estimate your website
will require?

 

 
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