*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?