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web design and development quotation request form

Complete the following form and submit to receive a quotation on your new website!

Business Name: *
Business Address: *

City: *
State:
Zip: *
Work Phone:
E-mail Address: *
Do you own a Domain Name: *	Yes No
Fax Number:
Your Domain Name (www.whatever.com):
Domain Name Purchased From:
Business Logo:	Yes, have logo No logo We need a logo
Do You Need E-mail Accounts: *	Yes No Dont know at this time
Approximate Number of E-Mail Accounts Needed (0 if none): *
Have you Purchased Web Hosting: *	Yes, have hosting No hosting What is hosting?
Hosting Provided by:
Do You Need a Website Store:	Yes, e-commerce necessary No, wont be selling anything on site Dont know at this time
Current Website Sales: *	Yes No
Current Payment Options: *	No options Cash or Check Paypal Private Bank Account Credit Cards
Pages Needed for Website *	About Us/Me Our Staff Our Services Our Products Shop Here Internet Specials Location and/or Directions Contact Us
Additional Pages Needed (one per line):
Changes will be made in-house when site is completed: *	Yes No
Web Design/Change Software Type:
FTP Software Used:
Colors to be Used on Site: *
Sites You Admire, either for aesthetics or functionality: *
Types of current advertising similar to web content: *
Web copy to be written by: *	Web Designer Someone In House Dont know at this time
Photos (electronic or hard copy): *	Yes, photos are available No, photos are not available Want designer to photograph We will photograph
Bussiness owns rights to current photographs:	Yes No Dont know at this time
Website will utilize forms (such as this one): *	Yes No Dont know at this time
Types of Forms Needed: *
Best Contact Person for Website Questions: *
Phone Number of Contact Person: *
E-mail Address of Contact Person: *
Current Web Address, if any:
Any Other Information:



* Required

judith a. westra agency, llc
553d gidley drive
grand haven, michigan 49417

616.846.4185 telephone
866.846.1087 just fax

jawa@judithawestra.com