EmailMe Form - Digital Visions Website Discovery

EmailMeForm

1. How should we contact you ?

Name *
First Last
Company Name
Email *
Phone *
### - ### - ####
Address

Street Address City State / Province / Region Postal / Zip Code Country / Region
2. Do you have an existing website? *
No,
If yes, please select option below and list
www.
3. Which hosting company do you currently use? *
None
Hosting:
4. If you answered "none" to #3, you will need a domain name. Example: www.mysite.com.
Please list you top 3 choices.
www. *
2nd Choice
www. *
3rd Choice
www. *
5. Have you found a existing website design that captures your vision?
No
Yes
If yes, please provide the URL:
www.
6. What is the nature of your website? *
7. Do you have a logo? *
No
Yes
If yes, Can you provide your logo on disk or send it by email? *
No
Yes
If no, Will you need a logo? *
No
Yes
8. Please select any of the following that you would like to incorporate into your website? *
Select all that apply.
8a. Select each that you can provide these on disk or send it by email. *
Select all that apply.
9. In summary, What type of products and/or services do you offer?
10. Will your company be selling products on your web site? *
No
Yes
Later
11. Will you authorize credit card payments on your website? *
No
Online(your website)
Manually
12. How often will your website need to be updated? *
Daily
Weekly
Monthly
Seasonally
Yearly
Other
13. Select all special features that apply. *
Select all that apply.
14. Select all database solutions that apply. *
Select all that apply.
15. What type of updates do you foresee? *
Select all that apply.
16. What is your budget for the design and development of your site? *
17. What is your target date for complete site implementation? *
MM / DD / YYYY
18. Please provide any additional comments or concerns.
How did you hear about Digital Visions Solutions? *

Please type the full name or company name if your were referred.
Sales Representative Name

Please type the full name

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