Web site questionnaire

Please take a few minutes and fill out the form below. Answer as many of the questions as you can. Online Media will contact you within 1 business day. Thank you.

** Required

**Name:

Company Name:

Address:

City:

State:

Zip:

Phone:

**Email:

 

Do you own a URL:

If yes, what is the URL:

 

What do you intend to use your web site for: (Sell products, provide service...)

 

Approximate # of pages:

Approximate # of images:

Approximate # of products:

 

Do you require a Secure area:

If yes, do you own a Secure Certificate:

Do you require Flash animation:

Do you require frequent updates:

Do you require custom programming:

 

Please give us some examples of sites you like:

 

Budget for web site:

 

The best way to contanct you:

 Phone   Fax   E-mail

 

Additional Comments:

 

  

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