All fields marked with a * are required and must be completed before the form can be sent.
First Name *
Last Name *
Company
Email *
Daytime Phone N° *
Street
Town/City
Post Code
Country
What kind of website do you want? Business Personal Both *
Do you have a Website Domain already? Yes No *
If yes, what is the domain name?
If no, what name would you like?
Do you have a hosting account already? Yes No *
If yes, who is your hosting company?
Purpose Provide Information Run an Online Shop Maintain a Blog Set up a Community Manage a Portal Other (Complete Text Box below) *
Description (200 chars left)
How many pages (approx.) will the site have initially? 1-5 5-10 10-15 15-20 20-30 30-50 50-100 100+ *
Will you need a Logo? Yes No *
Please provide two or three examples of websites, which come close to fulfilling your requirements. This will give us an idea of what you want.
Example Website 1 *
Example Website 2
Example Website 3
Elements Contact Form (with Anti-Spam) Location Map (Googlemaps) Online Forms(like this one) Guestbook Photo Gallery Slide Show Module News Item Module(Teaser) Newsletter Manager Forum Media Players (Video/MP3) Download Manager Banner Advertising Directory Listings Small Ads
Any others?
Member Registration Yes No
The ability to process Credit Cards Yes No
Will your site need to be multilingual? If yes, then which languages will you need? If it is monolingual, just click the default language of your site.
Choose Languages English German French Italian
Other Languages?
Will you provide the text? Yes No *
If no, do you want us to provide the text? Yes No, I'll get someone else
Will you provide the images? Yes No *
If yes, will you also prepare the images for the site? Yes No
If you wont be providing the images, do you want us to provide and prepare the images? Yes No
Once the site has been built, it will require some maintenance.
Will you keep the software up to date? Yes No *
If no, would you like us to do this for you? Yes No
Would you prefer to be able to add or change Information on your site yourself, whenever you want? Yes No *
