Request A Quote

Business Name:*

First Name:*

Last Name:*

Address:

City:

State:

Zip:

Phone:

Fax:

Email:*

What Are You Interested In?
	Website
	Print Media
	Email/Hosting
	Graphic Design
	Logo Design
	Corporate Identity Packages
	Other

Other:

Best Time To Reach You:

Describe Your Current Marketing Campaign, If Applicable:

How did you hear about us?:

Comments:

Overall Color Preferences	Corporate/Brand Look Developer's Choice
Purpose of web site (to inform, educate, sell, entertain, display, inspire, etc)
Do you have automation requirements?
Do you want sound on your web site?	No Yes
Sound Preferences

Layout

Desired basic overall theme (look/feel)
Do you have your own logo to use?	No Yes Please create a logo for me to use*

Information

Image (artwork, graphics, photographs, other visual images) requirements:	Do you need new images* (professional photographer services are available): No Yes Aerial photograph needed: No Yes 360 degree clickable virtual room/facility/house tour: No Yes Uncertain If 'Yes' how many:
Do you have the content ready?	No Yes Do you need help creating information for your website (creative writer services are available): No Yes Does your content need Editing? (client content reviewed and edited by a professional Technical Writer): No Yes
Would you like to display the current weather displayed on your home site?	No Yes

Database

If your web needs a database* to hold information/ collect information, describe the kind of database (such as Survey, inventory, internal use, customer information etc.)
If your web site will interface with an exterior database*, describe the interface between the web site and the database
Do you want to be able to edit pages on your own, using a custom login?* (Log in screen to web editing software):	No Yes
Do you want to be able to edit pages on your own, using an off the shelf webpage editor? (EXAMPLE: Frontpage)	No Yes
Is live chat capabilities required? (Get alerts to communicate with on-line web visitors in real time):	No Yes Uncertain
Will you require a shopping cart?	No Yes Uncertain
Do you need your shopping cart to integrate with a POS or Accounting software?	No Yes Uncertain
Do you need the use of forms (Example: Contact Us Form)	No Yes Uncertain
Do you want an e-mailed newsletter that clients and prospective clients can join from your web site?	No Yes

Hosting

Do you want to know about the traffic on your website? (Access to statistics or reports about web site hits, trends, etc.)	No Yes
How many email addresses are needed?

Maintenance

Do you want Microcharged to maintain web site information* for you? (3 available options are available):

No Yes

Marketing

Describe your target reach/market (age, gender, interests, education level, location, culture, lifestyle, hobby, income, etc.):
Is a branding consultant needed to help create a company identity (branding) for you?	No Yes
Do you need web marketing and technical consulting support?	No Yes
Do you require printed materials: business cards, posters, fliers, stationery, banners, brochures, etc.?	No Yes

Please Type The Following Characters In The Field Below:

If you have a website, please enter the web address:
What Domain Name(s) do you already have registered, if any?

	New Web Site
	Web Site Makeover