Website Design Form

Survey for web design by Randall Paul Pipes

Name * First Last
Phone - (###) - ### ####
Email *
Confirm Email *
Please check all that apply. * I need to register a domain name (I need my own website adddress - example: www.mysite.com). I need website hosting. I need graphic design (Artwork for website header, buttons, ads, etc.). I need a shopping cart. I will need on going website maintainance.
Please describe your project in as much detail as possible. Give the overall look and feel that you wish to accomplish. List the addresses of any websites that you really like and mention specifically what you like about each one. List how many pages and what you want on each one. Tell specifically what you want your website to do and the functions that you want it to have (calendar, forums, polls, etc.) *
Do you want to collect email addresses? Yes No
List how you plan to market or promote your website.
Other
If you have any artwork or text that you want to include, upload your files here.