Domain Services

Name:

First

Last

Occupation:

Company Name:

Website URL :

http://

Address:

City State Zip:

Country

Telephone - Day:

Telephone - Night:

Fax:

1	Do you already have your Domain Name registered?	Yes No
	If YES, please provide your domain name

2	What kind of information would you like to share with your customers or clients on your website?
	If OTHER, please specify

3	List the sections and an estimate of the number of pages for your desired website

4	Would your website require frequent updates and maintenance?	Yes No
	If YES, please specify by whom

5	Do you have your website already designed?	Yes No
	If YES, please specify by whom

6	Who is currently hosting your website for you?
	If OTHER, please specify

7	Are you satisfied with your Web Hosting Provider?	Yes Somewhat No

8	How many employees do you have?

9	Will all employees require an email address?	Yes No

10	When are you looking to have a global presence on the Internet?

11	Kindly give below a few dates with times that best suits you for a follow-up.

12	How did you hear about us?
	If OTHER, please specify

13	Did you find filling this form easy?	Yes No