PLUS WEB DESIGN QUESTIONNAIRE About Your Company Your Name * Company Name * Your Email Address * Current Website Address Address * Address Address Address Address Address Address Country Afghanistan Aland Islands Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bonaire, Sint Eustatius and Saba Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory Brunei Bulgaria Burkina Faso Burundi Côte d'Ivoire Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo Cook Islands Costa Rica Croatia Cuba Curacao Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic East Timor Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands (Malvinas) Faroe Islands Fiji Finland France French Guiana French Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Heard Island and McDonald Islands Holy See Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Isle of Man Israel Italy Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati Kosovo Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macao Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia Moldova Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island North Korea Northern Mariana Islands Norway Oman Pakistan Palau Palestine Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Puerto Rico Qatar Reunion Romania Russia Rwanda Saint Barthelemy Saint Helena, Ascension and Tristan da Cunha Saint Kitts and Nevis Saint Lucia Saint Martin (French part) Saint Pierre and Miquelon Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Sint Maarten (Dutch part) Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia and the South Sandwich Islands South Korea South Sudan Spain Sri Lanka Sudan Suriname Svalbard and Jan Mayen Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Timor-Leste Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States United States Minor Outlying Islands Uruguay Uzbekistan Vanuatu Vatican City Venezuela Vietnam Virgin Islands, British Virgin Islands, U.S. Wallis and Futuna Western Sahara Yemen Zambia Zimbabwe Country Telephone * Cell Phone * Years in Business * What forms of payment do you offer? (Please check all that apply) * Visa Master Card Amex Discover Paypal Cash Check Financing Hours of Operation * Design Preferences Company Colors * Are there any colors / designs you DO NOT want to see in your new website? Are there any websites that you’ve seen or styles that you’d like to incorporate into your new website? * Preferred Navigation Style * Horizontal Vertical No Drop Down Menus Navigation Text - Please tell us what pages/order you would like in your menus * About Your Current Marketing This information will help us to cater your new design to your services & your service areas. In addition, connecting your Google account to your new site is crucial! When we finish setting up your website, we will use this login to connect your analytics, webmaster tools, as well as submit a new sitemap to Google. Google Email Address * Google Account Password * How far do you travel? Please list your main service areas. * Please list ALL the services you offer. * Information for Your New Website Please list any Awards/Associations/Links that you would like to include: How much of the existing content would you like to bring over into the new website? Please be specific about pages you wish to drop/add. * Do you want us to write your website text for you? * Yes No We can professionally write optimized, unique content for your site! This service will add an additional payment to your current selection. Confirm that you DO want to add an additional payment to your plan for professional copywriting: * I am aware there is an additional payment for Professional Copywriting. Nevermind, I do NOT want to add copywriting. Additional Details Who manages your domain? Please provide the Login Id & password for us to access your hosting account: Dropbox Info Please upload a logo file to use: Drop a file here or click to upload Choose File Maximum upload size: 134.22MB For files up to 2 MB. If your logo file is larger than 2 MB, please wait and use our project manager or Dropbox to share your logo with us. Additional Items If you have before and after photos, pictures of your team on site, photos of your office, photos of your staff, etc., PLEASE use Dropbox to send them to us. Our company dropbox account is info@21stcenturywebdesign.com. Some Other Items You Might Consider Sending: Customer Testimonials Printed Advertising Media (brochures, flyers, etc.) Page Text (if different from current website text) Terms & Conditions By submitting this, you acknowledge that you have read and agree to our TERMS & CONDITIONS. You will receive a copy of our terms and conditions via email upon submitting this form. WHO WE ARE 21st Century Web Design Palm Bay, FL 32907 (321) 723-6945 www.21stcenturywebdesign.com Hours: Monday - Friday 9:00 am - 5:00 pm $-$$$ WHAT WE DO Web DesignInternet MarketingLogo & Print DesignTerms & Conditions READ OUR BLOG Website Launch Alert! – Why Food Works 4 Keys To Effective Web Design CONNECT WITH US