Website Request | AM Media Creators

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Organization Name:*
Your Full Name:*
Contact Information
E-mail Address:*
Phone Number:*
Address Line 1:
Address Line 2:
City:
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Zip Code:
Country:
Website Information Request
Please answer the following questions to the best of your ability. While not every question is required, the requested information will help guide the design and development of your websites.
Desired Launch Date:
Is your launch date fixed or flexible?:
Project Scope:
Projected Budget:
Describe briefly your dream website. (e.g. Number of columns, color...)

What is the primary purpose of the site? (e.g. To make a sell, to make an inquiry, to show your portfolio...)

How many pages are required? Could you list them all? e.g. Home, About, Portfolio, Contact...

Which of the following resources do you want on your website?	Content Management System
	E-Commerce (Shopping Cart)
	Blog/Discussion Board
	Image/Video Gallery
	Polls
	Site Statistics
	Search Functionality
	Newsletter Management
	Event Calendar
If other, please specify.

If e-commerce, how many products will you sell?
Will you be providing any of the content or materials?
URL of Websites you like (e.g. http://www.yahoo.com):

Competitors URL (e.g. http://competitor.com):

Current Web site URL (if applicable):
Domain Information:
Hosting Information:
Additional Comments

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