Stay in

 touch!

Thank you for taking the time to fill out our questionnaire.



Section 1 - General Information   *Indicates Required Fields


*First Name


*Last Name

Company

Title


Address

City

State


Zip

Telephone


Cell Phone

*Email


Other Information

and Comments


Section 2 - Your New Business




Do you have a domain name?     Yes         No


If Yes, what is it?

**If No, go to Section 3

If Yes, what company?

Do you have a Web host?          Yes         No


Section 3  - What Website Name Do You Want?   ** If you answered No to a domain name.


Choice #1: www.


Choice #3: www.


Choice #2: www.


Choice #4: www.


Section 4 - What is the Purpose of Your Web Site?




Comments: Please describe what you hope to achieve with your web site:

Informational

Sell Service/s

Section 5 - Keywords and Short Phrases to Find You on the Internet



Comments:

1.


2.


3.


4.


5.


6.


7.


8.


9.


10.


Choice #1: www.


Choice #3: www.


Choice #2: www.


Choice #4: www.


Section 6 - Graphic Look and Feel   Web sites that you think are most like the 'style' or 'image' you would like.

Section 7 - Logo, Photos, Graphics, Other Artwork, Animation, Sound




Comments:  Tell us more about any other artwork or graphics you would like:



Logo


Do you have a logo?  

Photos


Do you have photos for your web site?  

Graphics



Do you have any graphics for your web site?   

Flash


Would you like to have flash on your web site?

Sound


Would you like to have any sound or music on your web site?

If 'No’, would you like us to quote on developing a logo?  

If 'Yes', can you provide these by email?

Section 8 - Web Site Layout and Page Titles


Based on the example above, fill in your Web Page titles in the text boxes below.

Fill in only as many as you think you'll need.

If your site map contains more - add to comments below.

Home Page


Page Name #1


Page Name #2


Page Name #3


Page Name #4


Page Name #5

Page Name #6

Page Name #7

Page Name #8


Page Name #9


Page Name #10


Page Name #11


Page Name #12


More Web Pages
Website Design Questionnaire
Complete our
Website Design Questionnaire
and submit it online.





Please help us by providing as much information as possible. And if you have any questions call us at
914.260.4280.


Privacy Pledge:
TheComputerIcon believes that strong electronic privacy is crucial for the ongoing success of the Internet as a service, commercial, and entertainment medium.  We pledge that The Computer Icon will not release your personal data to anyone else without your consent.
The “Look and Feel” inspiration for The Computer Icon color palette.