* Required Fields

Contact Information

Business Name:

Contact Name: *

E-mail Address: *

Phone # (including area code): *
  Ext.     

The Basics

Are you needing a redesign or a new Web site? *

New Web site
Redesign, current site:

Do you have a domain name registered? If so, what is it
(if you have multiple domain names please list them here also):

If you do NOT have a domain name registered, would you like us to register one for you?
Please Select One... Yes. Please register a domain name for me. No Not Sure

Target Audience/Purpose of Website

Please describe your services, products and target audience. Who will be looking for your site?

Do you have a logo? Do you need a logo? Logo redesign?

Yes, I need a logo.
Yes, I have a logo but need it redesigned or touched up.
No. I need a new logo designed.
No. I do not want/need a logo at this time.

Do you have existing material for your product/idea in the form of brochures, pamphlets, CDs, video, flyers, etc?
If yes please explain:
Please select one... Yes No

Time & Budget

What is the desired time frame for completion of this project?
Please select... 1-2 Weeks (Emergency) 1 Month (Priority) 2 Months (Typical) 3 Months (Medium Size Projects) 3-6 Months (Large Projects) Anytime Not Sure

What is your budget?
Please select... $1000-$1500 $1500-$2000 $2000-3000 $3000-$5000 $5000-$10,000 $10,000-$20,000 $20,000-$30,000 $30,000+ Not Sure Other

Search Engines

Do you want your site optimized for Search Engines?
Yes No

Do you want your site registered/submitted to Search Engines?
Yes No

Look & Feel

1) If you need a REDESIGN, let us know EXACTLY what you do NOT like about your current site and what you would like to change:

Are there any Web sites you'd like us to follow or any Web sites that you like?

Layout - What pages & features do you need?

Do you intend to maintain the web site yourself?
Select Yes No Not Sure

Give us a brief overview of your project to help us determine how many pages your site will be. As an example, consider the following outline:

In the example above there are 19 pages (7 main pages with 12 sub pages) for the project. It is very helpful if you are able to provide an outline similar to this. You can view a semilar chart here to help you plan.

Exact or Approximate Number of Pages:

Database & Interactivity

If your project requires any interactivity that will need a back end database, please describe your needs specifically as possible below. Examples of database functionality are log in areas where users can populate information and record storage/manipulation/retrieval.

Explain the type of functionality you'll need. Be as detailed as possible:

Additional Services & Features You Would Like to Add to the Web Site

Please check a box next to the features/services you would like to have on your site.

Calendar of Events
Audio Clips
Video Clips
Live Video Streaming
Adobe Flash Design
Bulletin Board
Shopping Cart
Chat Room
Files for Download
Forms
Guestbook
Live Web Cast
Password Protected Area
Rollovers
Virtual Tours
Other
Explain:

How did you hear about TEQ Media Group?
Please Select One... E-mail Newsletter Referral From Other Client Radio Print Ad Banner Ad Local Print Media Phone Book/Local Directory Search Engine Word of Mouth Website Link Other

Would you like to receive the TEQ Update Quarterly Newsletter?
Yes, please. No, thank you.