First Name: *

Last Name: *

Business/Organization Name (if any):

Address 1: *

Address 2:

City: *

Prov/State: *

Country: United States Canada Other

Postal/Zip: *

Home Phone:

Bus. Phone:

E-mail: *

Fax #:

 Website Information

Will this project be a new site or site redesign? New Site Redesign

If yes, what is the address for the current website?

Web Site Category: Personal Business Non-Profit Professional Educational

Web sites' primary function:
Information Sell Products or Services Combination

Do you currently own a domain name? Yes No

If no, do you wish us to register a domain for you? Yes No

Do you require hosting for this site? Yes No

Approximate number of pages (One page is equivalent to an 8 1/2" by 11" printed sheet of paper) : 1 2 3 4 5 6-10 11-20 Over 20

Additional Elements: Please select all that may apply from the list below.

Please specify if you choose "other" from the list above:

Will you require maintenance service for this site? (Regular updates and additions are vital to keep your visitors coming back. Banion Webworks provides maintenance service
on a hourly basis or a fixed time/month plan.)
Yes No

Will you require custom graphics for this site? (Custom graphics would include any .gif or .jpg images we would design to make your site distinct in the visitors mind, such as a logo. Navigation buttons, bars and backgrounds are included in your Web design quote as part of the basic design.)
Yes No

If you answered yes to the above question, please provide details:

Do you have color preferences?

If you have a logo, do you have it available in digital format? Yes No

Will you require images to be scanned? Yes No

If yes, approximate number of images to be scanned: None 1 2 3 4 5 6-10 11-20 Over 20

Any further information you wish to provide or isn't covered above: