For Sales Call:
973-897-9006

Thank you for your interest in Integrated Minds and the many Internet technology services we provide. Please fill out the form below to the best of your ability. The goal of this questionnaire is to provide us with enough information to evaluate your needs and present to you a proposal including an estimated budget.
Name (First,Last):
Address:

City, State, ZIP:
Email:
Phone:
Fax:

Company Name:
Business Type:
Company Address:

City, State, ZIP:
Company Phone:

How do you prefer we contact you?

Phone Email

If by phone, which phone number?

Home Company

When is the best time to call?

What type of web site are you interested in?

Will this be a new web site, or an upgrade?

New Upgrade

What is your budget size?

approx.

Do you own a domain name?

Yes No

   If so, please specify.
   If not, what names do you have in mind?

Do you need web site hosting?

Yes No

If so, how many Email addresses will you need?

Would you like your web site promoted?

Yes No

If so, please select the types of promotion you are interested in.

Search Engine Submittals	Search Engine Results Monitoring
Banner Advertising	Off-line Advertising Campaigns
Link Exchange Campaigns	Other

Who will be your target audience?

How many pages would you like on your web site? approx.

Will your web site require updates on a regular basis? Yes No

If so, how many, and how often?

Will you provide content for your site?

Yes No

If so, what form will the content be in?

How will you send us the content?

Please check all of the following that you would like on your web site.
Intro/Welcome Page Services Page Products Page Pricing Page Contact Page About Page Order Form Testimonials Page Custom Database Application	Site Search Message Board Graphical Navigation Buttons Flash Animation Streaming Audio Animated GIF's Streaming Video E-commerce (Store Front) Real Time Credit Card Processing
Other(s) (please specify)

Please describe in as much detail as possible, the conception you have for your web site. i.e., concept, plan, design, ideas, envision...
What color scheme would you like to use on your web site?
What keywords would describe your web site?
Comments: Please specify any additional comments below.

For Sales Call
973-897-9006

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