*Name:

Company Name:

Address:

City:

State: Zip Code:

*Email Address:

*Please contact me by (choose one):

      Email    
      Phone  
              My Phone # is: ( )

* Please give us a brief description of your personal needs for your web site or of your business . If you have chosen to have us call, please include a time frame with time zone for when it is best for us to call you.

Have you seen any websites on the web that have the look you wish your site to have? (If so, this them below. This will help us understand the presence you wish to have.)

http//
http//

What level of internet presence do you wish to have?

Family or Personal Site
Informational to present your products and/or services
E-Commerce site, number of products:
      1-25 26-50 51-100 101+

What you do wish to achieve with your new online presence?
(Choose all that apply)

To give information about myself (for example: my resume or hobbies, etc.)
To start a new business
To attract new customers to existing business
To take advantage of E-Commerce
To improve customer relations
Other (Please specify:)

Does you currently own your own domain name(s)?
Yes      No

Do you currently have a web site?
Yes      No

If yes, what is your site's URL?
www.

If inquiring about an e-commerce site, do you already have a merchant account?      Yes       No

If yes, with who?     

If inquiring about an e-commerce site, are you interested in using the osC Complete shopping cart program?      Yes      No

If yes, we can customize the OsC Complete to meet your needs. Would you be interested in customization?      Yes      No

Estimated number of web pages needed:      
NOTE: To keep your pages loading quickly, a general rule of thumb is a maximum of 6 graphics/images with text and buttons per page.

Check here if unsure on number of pages needed.

How about any of our other services?
(Choose all that apply)

How soon do you need your website?

How did you hear about us?