Your Name:
Company:
Street Address:
City, State, Zip:
Phone:
Email Address:
Web Address:

How did you hear about us? Existing Client WOL Radio 
Praise 104.1 FM Radio TC's Sista Cirlce PGCC
Laurel College GospelSpirit.com  Joe Madison Search Engine 
R.Gatewood Radio Interview Office Sign
Referral (Who referred you? )  
Other 
Do you have a web site ?  Yes  No
Have you registered your domain name ?  Yes  No
How long have you been in business?
If a new, briefly describe your service and your company?

What is your main service or product? (generates most of your revenue) 
Do you have a  merchant account (can you accept credit cards)?  Yes  No
How do most of your customers pay for service?
Cash  Check  Credit Card  Monthly Billing  Other 
Do you have the following? (click all that apply, hold "Ctrl" key while clicking)
Brochure  Flyer Marketing Plan  Business Card  Photos of your product/operation  Dedicated Fax Line  Customer/Prospect Data Base 
What is the purpose for your web site (if applicable)? (click all that apply, hold "Ctrl" key while clicking)
Dispense Information  Take Orders On-Line Recruit Members  Raise Funds  Add Credibility to the Organization  Reach a Larger Audience  Gain a Competitive Edge 
Which of our services do you feel closest fit your needs and /or budget? (if more than one, include in comments)
Jingle Production
Basic 1- 3 Page Web  Design 
Executive 5 - 8 Website Design 
E-commerce Website (sell product online)
Custom Website Design
Maintenance for an Existing Site
Web Hosting
Audio, Video Web Design
Logo  Design
Graphic Design Services (Brochure, Flyer, Ad, etc.)
Web Advertising (banner ads, search engines, etc)
Marketing Services
Media Buying
Sales Training / Seminar
Other 
 
If you would like to come into our office for a FREE 30-minute consultation or if you have comments or other information that you feel will help us help you, please indicate below: