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Response-O-Matic Form 

Thank you for visiting my site!

Your comments and interest are appreciated!

 

Please fill out as much information as possible so we can assist you

to the best of our ability and provide you with a more accurate quote.

Click on the Submit button at the bottom when you are ready to send.

 

Your name:

Your Email address:

When do you want to place your business or personal site on the internet?

today

this week

this month

not sure yet

Do You currently own a Domain Name(s)?

No

Yes

If You checked Yes, Please type the "main" Domain Name below:

www.

ie. yourname.ca/com/net/org

If you checked No,

Type a couple of names below. We will check their availability for you.

www.[22 characters Maximum, No spaces].com

www.

www.

www.

Please select the type of website that you are interested in having us develop for you.

Create a business website

Create a resume

Announce an engagement

Announce a wedding

Welcome a new baby

Create a memorial page or site

Share with others about your hobby or club

Other (Please specify): Business (Please specify type of business or service you offer):

Estimated number of pages your website may consist of: 

Estimated number of images to be used on your website: 

These can be sent to us on a harddisk/cd (ie: JPEG / JPG / GIF / TIFF) OR

we can scan them for you (ie: POLAROID / 35mm PRINT / Brochure or other printed format)
 

Do You have a Hosting company picked out yet?

Hosting means a web-server that stores Your Website's information & Domain

Name (yourname.com) and is connected to the Internet via a highspeed data

line. All hosting company's charge by the month for this service. We can set

up hosting for you. There are also FREE hosting companies we can help you set up.

No

Yes

 

Have You seen any other Websites on the net that have the look your looking for?

(If so list them below to better help us envision what you want)

1. http://

2. http://

3. http://

 

Will Your site require updating?

(newsletters, poems, sale items, wedding pictures, update hobby, sports

scores, photos, items to be added or deleted, freshen up look of site, etc...)

No

Yes

If you checked Yes, how often?

daily

weekly

monthly

quarterly

biannually

annually

How many of the following would you like to have included on your homepage?

counter set-up

guest book set-up

links to external pages

feedback / information form

company logo

 How did you hear about Le Loup Webpage Design?

 

Any additional information / comments?

 

Please remember, your information will be kept strictly confidential.

 

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