Business Name Contact Name Contact Email Address Contact Phone Number Contact Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country What type of website do you need? Basic Site (For Beginners) Pro Site (For Professionals) Ecommerce Site (For Online Sales) Website Redesign (For Upgrading Your Look) I don't know. On what website will this content reside? (What is the domain name for the website?) What is the site's main focus and purpose? What is the requested due date for the project? What is your budget for this project? Less than $1,500 $1,500 - $3,000 More than $3,000 Which descriptions best fit your brand? Select all that apply. Conservative Edgy Casual Professional Funny and Playful Serious Stylish and Fashionable Plain and Practical Thrifty Affluent Outspoken Reserved Green and Environmental Some other description? Do you have a logo? Yes, I have a logo that can be used on the site. Yes, I have a logo, but I would like to create a new one. No, I would like a graphic designer to create a custom logo for me. No, I would like a simple wordmark logo created for me. I don't know. Do you have any color preferences for your website? If so, please list them. Please add links to any websites with a design style you would like to see reflected in your site.If you could hire any person to be the spokesperson for your business, who would it be? (a public personality, celebrity, athlete, politician, etc.) Briefly describe your target customer.Please list the services or products your business offers, and what problem you solve for your customers or clients.What is the main call-to-action you would like on the site?A main call-to-action could be to sign up for a newsletter, download a free ebook, sign up for a free consultations, buy a certain product, etc. What makes you different from your competitors?If you have a website, what don't you like about your existing site?Please provide any additional requirements, instructions, or information you have. If you have additional information, images, or other collateral that will be important to the creation of the websites, please email it to raubi@simplystatedmedia.com. Δ
