Needs Form - Describe your needs to see what I can do for you:
Save time and money with me.  This is a no cost and no obligation form

What is your name?          First      Last
What is your E-mail address?  
Which of the following describes your web needs?  
  E-commerce (Selling)
 General Website
 
Which of the following describes your web needs?  
  Personal Use
 New business- exploring web design options
 New business - have a web design budget
 Established business - exploring web design options
 Established business - have a web design budget
 
What type of services are you currently looking for?
  Design a new site
 Redesign of an existing site
       please indicate URL:  www.
 Maintenance to an existing site
       please indicate URL:  www.
 Other (please specify):    
 
Will you be providing any content for the website design? (Check all that apply)
  No - I need help with all aspects of my website
 Yes - I will provide text for my website
 Yes - I will provide images for my website
 Yes - I will provide layout/site map for my website
What is the budget for creating your website?
  $
 
When would you like your web design project to start?
  ASAP
 Two weeks
 One month
 More than two months out
 
Have you already registered a domain name for your site?   *Please note, we provide FREE domain name registration with any hosting plan for .com, .net, and .org
  Yes
 No
 
Would you like Rich Hershey Web Design and Hosting to host your site?
  Yes
 No
 
Please describe the focus of your website and any additional requirements you may have: (2000 characters maximum)
 
 

 


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Rich@RichHershey.com
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