Your Name:

Title:

Company:

Address:

Please give physical location and mailing address including suite numbers

City:

State & Zip:

Phone (include Area code):

Fax (include Area code):

Email Address:

Current Website, if any:

What is the main focus of your business?

How many employees
 do you have?

None: Just me and/or partners 1-5 6-10 11-20 21 or more Multiple locations

What is your current
sales volume?

Under $25,000/year $25,000 - $50,000 per year $50,000 - $100,000 per year $100,000 - $500,000 per year More than $500,000 per year

What current advertising/marketing/
promotions do you do?

List anything such as tv, radio, print ads, billboards, etc.

What is your main reason for wanting/having a website?

What are your goals for the future of your company?

What are your goals for your marketing program?

Do you currently have an advertising/marketing agency?

 Yes       No

Do you currently have adequate systems and proceedures in place for processing your current volume of work?

 Yes       No        Not sure

Do you honestly think those systems will continue to function well if your sales volume increases by 10-50%?

 Yes       No        Not sure

Can you and/or an employee devote 8-24 hours a week on promotional/website activities without the rest of your business suffering?

 Yes       No        Not sure

What do you see as your biggest obsticles to growing your business?

Is there anything else you think we should know or you'd like to tell us?