Please complete this website questionnaire and click on the submit button located near the bottom of the form.  A confirmation page will appear with the information submitted to AlyAnya & Associates.

Questions! 330.327.6973 or email

Contact Information:

*Company Name:
Address:	Phone:
*Contact First Name:	How did you hear about AlyAnya & Associates? Select from List Referral Website Search Engine Just Surfed In
*Contact Last Name:
*Email:	* In order to prevent the use of automated registration programs, please enter the code number shown.

Services:

What Web services are you interested in? Check all those that apply.

Web Site Design & Development	E-commerce	Redesign of Current Site
Logo Design	Search Engine Advertisement	Other
Custom Design	Web Site Hosting
Web Site Maintenance	Domain Name Registration

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Who will be the contact person(s) for your Web site?	Will this be a new web site design or redesign of existing web site? Select from List New Design Redesign
What is the budget for your project Website (U.S. Dollars)?         * Does this include hosting and maintenance? Select from List No Yes	If you already have a web site, then will you be using your existing content? Select from List No Yes
Is there a deadline for this project? Select from List No Yes

Background:

Describe the nature of your business.	List the services that your company currently provides:
How many pages do you anticipate that your web site will have? * Select from List 1 2 3 4 5 6 7 8 9 10 or more	How many online forms do you anticipate that your web site will have? Select from List 1 2 3 4 5 6 7 8 9 10 or more

Goals, Purpose, Concept, Focus, Direction, Strategy and Message

What is the core purpose of your website? Check all those that apply.

Entertainment	Improve internal communication
Increase corporate, brand, product recognition	Increase prospective customer base
Reduce customer service calls	Gather data
Increase sales	Other

Logo and Corporate Identity

Do you have a company logo? Select from List No Yes	Do you have a corporate color scheme or any symbols/icons that should be incorporated in your web site design? Select from List No Yes
Do you have a company slogan and/or mission statement? Select from List No Yes

Content

Do you already have an image/graphic content for your web site? Select from List No Yes	Do you have text content readily available for your web site? Select from List No Yes
Do you require assistance scanning or preparing your images? Select from List No Yes	Would you like assistance to develop textual content for your web site? Select from List No Yes
Approximately how many images would you like to use on your web site? * Select from List 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 or more	Do you have anything in mind for background images or colors for your web site? Select from List No Yes

E-commerce

Are you going to accept credit cards for online purchase? Select from List No Yes	List the name of your merchant account if you have one.
If so do you currently have a merchant account? Select from List No Yes	How many products and/or services do you plan to sell?

Maintenance

Would you be interested in updates and maintenance to your web site? Select from List No Yes	Would you be interested in promoting your web site and/or register your site with search engines? (e.g., Yahoo, Googles, MSN, etc.) Select from List No Yes
How often would you require updates? Select from List Daily Weekly Monthly Quarterly Other	If you already have an idea of your own domain name, then please enter the name here (e.g., yourname.com or yourname.org)

Set-up & Hosting  Do you currently have a web hosting package? Select from List No Yes If yes, then what web hosting company currently hosts your site? Would you like help in acquiring and registering a domain name? Select from List No Yes What email software do you currently use? (e.g., Microsoft Outlook, IncrediMail, Lotus Notes) Would you like access to web statistics/counters on your site? Select from List No Yes Would you like a Custom Blog Page as part of your web site? (Online Interactive Social Community)  Select from List No Yes

* Asterisk means Required Fields

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Designed and Created by AlyAnya & Associates Last modified: 09/21/11