Design Contact		Content Contact
		(If Different)
Company Name		E-mail Address
Phone	Ext.	Fax

Anticipated Site  Page Count

Single Page

2-5

6-10

11-15

16-20

Other

Do you wish to have a domain name Registered  (www.yourname.Com)?	Yes I need a domain name	No I have a domain name	No I will use Romore.com/my name
Please list your top 3 domain name choices in order of preference.
(Click to check a domain name)

Tell us about your current Internet access and ISP/OSP (Internet service provider).
Providers Name	Do they provide you with web hosting space?	Personal	Business or Personal	No hosting

What speed is your current Internet connection?	56K	Cable/DSL	T1	Other
You anticipate that your site is going to grow?	Not at all	Slowly	Moderately	Quickly

			What is the purpose of this site? (Advertising, News, Information, Membership, Sales, etc.)		My objectives are:

Please tell us about your time constraints for this site.
Start Immediately	1 to 3 Months	3 to 6 Months	6 - 12 Months	More than 12 Months

What custom graphics will be required (check all that apply)?
I need a logo designed	I have a logo	Advertising Graphics	3D Graphics	Animated Graphics
Multimedia Graphics	( Java Applets)	Other Custom Graphics

What other special features or formats might you need (check all that may apply)?
Midi Files (music)	Wav Files (voice)	Custom Flash	Shockwave	Streaming Audio
Streaming Video	Multimedia (movie)	Acrobat (PDF)	Chat Rooms	Custom Java Applets
Bulk E-mail Services	Site Search	Custom Forms	Guest Book	Subscription Services
Newsletter Services	Digital Certificate	Database	Frames	Site Statistics Reports
	Bulletin Board			Search Engine Submission
	Shopping Cart	Secured Server	Adult Content	Credit Card Transactions

Connectivity to external systems (host/mainframe, reservations, accounting, communications, telephone, etc.)  If yes please describe connectivity issues.

Background Use
one color background	background image	I don't know what background to use
	(May load a bit slower but could look better)

Graphics Use
Text only NO images (fastest)	Minimum images(appealing, fast)	Moderate images (more appeal, slower loading)
Lots of images (max appeal to bad if they don't have fast access!)		Don't know how many images.

Please provide any other details or special instructions that might help us best serve your goals or customize your site.

Mailing Address		Line 2
City	State	Zip