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Thank you for taking the time to fill out this questionnaire. Defining your needs will result in a well designed site that you will be happy to call yours! Please be sure to include your e-mail address or telephone in case more details are required. (All information is kept confidential)

General Information

First Name:
Last Name:
Business/Organization Name (if any):
Address 1:
Address 2:
City:
Prov/State:
Postal/Zip:
Home Phone:
Bus. Phone:
FAX #:
E-mail:

Website Information

Will this project be a new site or site or site redesign?

If “Re-design”, what is the address for the current website?

Website Category:

Website's primary function:

Do you currently own a domain name?		Yes No

If "no", do you wish us to register a domain for you?		Yes No

Do you require hosting for this site?		Yes No

Approximate number of pages (One page is equivalent to an 8 1/2" by 11" printed sheet of paper):

Additional Elements: Please select all that may apply from the list below:
Guestbook Shopping Cart Other
Mailing lists Feedback Form

Please specify if you choose "other" from the list above:

Will you require maintenance service for this site? (Regular updates and additions are vital to keep you visitors coming back. Z Internet Solutions provides maintenance service on an hourly basis, or as a fixed time/monthly/quarterly plan.) Yes No


Will you require custom graphics for this site? (Custom graphics would include any .gif or .jpg images we would design to make your site distinct in the visitors mind, such as a logo. Navigation buttons, bars and backgrounds are included in your web design quote as part of the basic design.) Yes No

If you answered "yes" to the above question, please provide details:


Do you have color preferences?


If you have a logo, do you have it available in digital format?	Yes No

Will you require images to be scanned?	Yes No

If "yes", approximate number of images to be scanned:

Any further information you wish to provide or isn't covered above: