Intake Form

Your Name:*
First Last
Email Address:*
Enter Email Confirm Email
Priority:*
- 1 (Very Low)
- 2
- 3
- 4
- 5 (Very High)
Needed By:*
MM slash DD slash YYYY
Type of Request*
Choose as many as are relevant.
- Website Design / Development
- Website Hosting
- Website Repair / Support
- Videography
- Graphic Design
- Writing Services
- Strategic Consulting
- Project Management / Operational Support
- Mentoring / Training
Do you currently have a website?*
What is your website URL?*
Tell us more about your company, organization, or yourself.*
What kind of story do you want your website to tell? Who are you?
What sort of website do you need?*
- Academic: Journals, education-related, cv's, etc
- E-Commerce: sell services or products
- Membership: Organization or club
- Personal: Blogs, photos, or vlogs
Do you have graphics for the site?*
- Yes
- No
- Not Sure
What would you like your website to do?*
Choose as many as are relevant.
- We're here: create an Internet presence
- This is who we are: reflect vision/purpose
- We're the best: be better than competitors
- Provide knowledge: feature information about products and services
- Sell lots of stuff: a large online storefront, advertise and/or sell many products and services
- Sell a little stuff: an online storefront with just a few products
- Join us: Allow people to join our organization or club / learn about our organization or club
- Learn about me: personal website with information about myself, my resume, etc.
- Create a resource: e-journal, wiki, directory, etc
- Privacy please: Private members-only section - password protected
- Gather information: have forms and question sets
- Disseminate information: provide subscriptions to newsletters/blogs
- Other
Other:*
Please Specify
Define your website style for us, please.*
Find a few websites ( preferably in the same genre as your site ) & tell us what you like and don't like.
Describe the colors and feel that you'd like to see in your site.*
What is your target audience?*
What are your budget requirements or restrictions?*
Check any of the following that apply:*
- Our site should have a very professional style and feel.
- Our site should be warm, welcoming – casual.
- Our site should load quickly – less graphic intensive.
- Our site should feature lots of cool graphics, animation.
- Our site should be easy for us to maintain ourselves.
- Our site should be accessible to everyone ( the blind, deaf, & so forth, following guidelines).
- Other
Other:*
Please Specify
How many pages will you need for the site?*
Who referred you to us?
Additional Information (if needed)