Company Name*:

Contact*:          

Position/Title*:    

Address*:            Suite/Apt:

City*:      State/Prov*:

Country*: Zip/Post Code*:

Phone*:   Fax:

Best Time to call*: AM PM

Web Site*:   http://

E-mail * (Be sure to enter a valid address) 

Years in business*:

Brief Description of Business and Web Site Objectives*:

Yearly Revenues: < 500K < 1M 1M to 5M Over 5M

How do you sell your products & services*? (Check all the apply):

Online Retail Store Dealers Other Describe:

Some brief questions to help us with our review

1. What results are you not accomplishing online that would you like to see*?

2. What actions do you want your web site to drive (check all that apply)*:

Online Sales Sales Leads Other Describe:

3. Do you feel that you should only invest in proven methods of marketing and business development on line*?

Yes No Don't Know

4. Is there a dollar amount or revenue percentage allocated to support your Internet investment*?

Yes No Don't Know
If "yes", how much:

5. What time frame did you have in mind for completion of this effort*?

Immediate 30 days 60 days 90 days+

6. Do you have a budget set aside for this effort*? Yes No Don't Know
If "yes", how much?

7. What are the top 3 issues or challenges facing you and your business as it relates to increasing the ROI of your Internet investment*?

8. Comments/Questions: