Please complete the following questions, so we can understand your needs and schedule your work. Are you a new client? Yes No CONTACT INFORMATIONPlease provide your contact information.Name* Mr.Mrs.MissMs.Dr.Prof.Rev. Prefix First Last Suffix Company or Organization Name*Please enter your company, non-profit or organization name. Email Address* Enter Email Confirm Email Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Phone*Website Address* REQUESTS:Request Type*What do you need help with? Please check below: Technical Assistance Maintenance Minor Change Major Change Re-design New web site Other, Please define below Technical Assistance Detail*Briefly describe the issues with your web site. Please be specific and include error messages, page names, sections, etc. Maintenance Detail*Briefly describe the small change you need. e.g. " Add an event to my calendar, Update a team member, Change a menu, etc." Minor Change*Please select the type of small change your web site needs:Add or change a linkChange page contentAdd an imageAdd a PDF fileAdd a pageOther (Define)Major Change*Please select the large change your web site needsAdd a new sectionAdd a sidebarAdd a blogAdd a formAdd an email subscription signupAdd my blog to an email campaignAdd social media iconsAdd Paypal link to accept paymentsAdd a new function (Describe below)Re-design*Please select the type of re-design your site needs. You will be directed to another form for more details.Change the design themeConvert my site to WordpressChange the navigation / menusAdd a shopping cartOther (Please define)Describe Design Modifications:*Briefly describe why you want to change your web site. Any major functional or visual changes require additional details from you, extra analysis and time from us. You can assist us in understanding your needs , by completing the next form. Please click here to request a new web site or redesign.LINKSNumber of Links*How many links need to be changed? You can specify up to 5 links.Please enter a number from 1 to 5.Link Change 1:Please select an option. You will be prompted for up to 5 pages/links. Add a link Change a link Delete a link Page Name 1:*Please provide the page name where the link should be added, changed or deleted. Link TEXT 1*Please tell us what text should be highlighted for this link. Link / Web Address 1*Please give us the external web address or page name that this page should link to. Examples: For external sites: list the web address: "http://www.example.com/page". For your site, list the page name, "Home" "Contact Us" IMAGES:Note: We can help edit and size your images, at an additional charge. Just let us know what you need.How many images do you want to add?*Please complete the following fields for EACH image. If you have more than 5 images to add, please email them to us and include the page name and location where images should be placed.Please enter a number from 1 to 5.Page Name 1:*Please provide the page name where this image should be added: Image 1 Placement*Please indicate where the image should be placed on the page.Centered Above textCentered Below textLeft of textRight of textUse your best judgement for best displayOther (please define)Upload Image 1*Please upload image 1Max. file size: 256 MB.Page Name 2:*Please provide the page name where this image should be added: Image 2 Placement*Please indicate where the image should be placed on the page.Centered Above textCentered Below textLeft of textRight of textUse your best judgement for best displayOther (please define)Upload Image 2*Please upload image 2Max. file size: 256 MB.Page Name 3:*Please provide the page name where this image should be added: Image 3 Placement*Please indicate where the image should be placed on the page.Centered Above textCentered Below textLeft of textRight of textUse your best judgement for best displayOther (please define)Upload Image 3*Please upload image 3Max. file size: 256 MB.Page Name 4:*Please provide the page name where this image should be added: Image 4 Placement*Please indicate where the image should be placed on the page.Centered Above textCentered Below textLeft of textRight of textUse your best judgement for best displayOther (please define)Upload Image 4*Please upload image 4Max. file size: 256 MB.Page Name 5:*Please provide the page name where this image should be added: Image 5 Placement*Please indicate where the image should be placed on the page.Centered Above textCentered Below textLeft of textRight of textUse your best judgement for best displayOther (please define)Upload Image 5*Please upload image 5Max. file size: 256 MB.Image File UploadYou can upload up to 10 images in jpg or png format. Please rename your images so we can easily identify them. Example: An image named img001.jpg doesn't help us, when we're trying to place it on a page, but we can identify an image of daisies, called daisies.jpg Drop files here or Select files Accepted file types: jpg, png, Max. file size: 256 MB, Max. files: 10. CONTENT CHANGES:How many pages do you need to add or change?*Please enter a number from 1 to 10.Note: We provide Writing Services to copy write or edit page content by the hour.Page Name 1:*Please list the page name you want changed or added. Content Upload Files*You can upload up to 10 files in doc, docx, PDF or txt format. Please provide meaningful names that match your PAGE NAME. For content changes, it makes our life so much easier, if you can highlight the changed text. Drop files here or Select files Accepted file types: doc, docx, pdf, txt, Max. file size: 256 MB, Max. files: 10. How many pages will have images?*1-1010-2021+PDF DocumentsHow many PDF documents?*Please enter a number from 1 to 10.Are your documents in PDF format?*Downloadable documents should be in PDF format so visitors can read them on any computer, tablet or mobile device. My documents need to be converted to PDF format ALL my documents are in PDF format Note: We can convert your documents to PDF format starting at $5 per documentHow many documents need to be converted to PDF format?*None1- 56-1011-2021+PDF Page Name 1Identify Page where PDF should be attached. Upload PDF FilesYou can upload up to 10 files. Please provide meaningful names so we can easily identify the files. Drop files here or Select files Accepted file types: pdf, doc, docs, Max. file size: 256 MB, Max. files: 10. ADDITIONAL FEATURES & FUNCTIONSBLOGSDo you want to add your blog to your main menu?* Yes No Blog Name*What is your blog's name? This is the name that will appear on the menu, the top of the Blog page, Links on your web sites, etc. Examples: "Blog, My Writings, Daily Inspirations" Do you want to automatically send new blog posts and/or newsletters to your subscribers?* Yes No Do you have an account with a Mailing List Service?*(examples: Mailchimp, aWeber, Get Response do; Constant Contact doesn't) Yes No I have one but I don't know Please make a recommendation Do you need assistance creating an email template?*Templates can be created to coordinate with your web site's design using the logo, header image, colors, etc. Yes No thanks, I'll do it myself SOCIAL MEDIACheck any of your Social Media Account Links you want to appear on the site*Please check all that apply Facebook Twitter LinkedIn YouTube Pinterest Tumblr Other (Please Define) NO Social Media Provide your Facebook Link: Provide your Twitter Link: Provide your LinkedIn Link: Provide your YouTube Link: Provide your Pinterest Link: Provide your Tumblr Link: Identify Other Social Media Sites* Do you want visitors to be able to share your web site on THEIR social media accounts, to increase your site's reach?* Yes No FORMSDo you need a custom form?*Please check all that apply Contact Form Subscribe to my Mailing List Payment/Subscription Donation Event Registrations Intake Forms Online Survey or Questionnaire Other - Please define below How many Custom Forms will you need?*Custom Form 1*Please define custom form 1 Custom Form 2*Please define custom form 2 Custom Form 3*Please define custom form 3 SELLING PRODUCTS or SERVICESAre all payments in US $ currency?* Yes No How will you accept payments?* Link to Paypal Order Form that links to Paypal Payment Form that links to Paypal Link to an external shopping cart site I need a shopping cart I don't know. Please make recommendations NEW FUNCTIONSSelect additional features you think you want to add:*Check all that apply Google Map Upcoming Events/Calendar Password protected pages or area in your site Nothing extra thanks Other (Please define below) Define Additional features you need? Define Additional features you need? Define Additional features you need? SCHEDULING and OTHER BUSINESS STUFFDate Needed*Please select one of the following options: We are always juggling many projects. We do our best to accommodate clients' needs. Emergency (24-48 hours) ASAP, but I'm in no rush Whenever you can fit me into your schedule I need it by (specify date below) I'm just starting to think about this Desired Delivery DateWe are always juggling many projects. We strive to meet your scheduling needs, but unfortunately, we can't always guarantee it.. MM slash DD slash YYYY Do you have a maintenance agreement with us? Yes No Note: Clients with maintenance agreements are charged a discounted rate against the balance in their accounts. Hours exceeding the balance, will be charged at our usual rate. We strive to provide turnaround ASAP, but we cannot guarantee 24/7 support or immediate scheduling. Do you have a promotion code?*We often give discounts, please enter your promotion code below: Yes No Promotion Code What else do we need to know? Any needs not covered in this questionnaire?