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


Company Name:








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: