Name
:
Company
:
Phone
:
Fax
:
Email
:
Existing website
address (if any)
:
What
type of service(s)
Do you
require? (tick all that apply)
:
Web design
Flash
Introduction
Online
forms
Graphic
or logo design
Flash
navigation
Database
Solutions
E-commerce
solutions (shopping carts)
Audio
streaming
Video
streaming
Site
maintenance
Self
content management system
Search
engine optimization
Marketing
Consultancy
What
is your budget in Indian Rupees?
(minimum project Rs 5000)
:
Rs
5,000 - Rs 12,000
Rs
12,000 - Rs 20,000
Rs
20,000 - Rs 40,000
Rs
40,000 - Rs 80,000
Rs
80,000 - Rs 1,00,000
Rs
1,00,000 - Rs 5,00,000
Rs
5,00,000 - Rs 15,00,000
Rs
15,00,000 - more
What
materials will you be
providing? (tick all that apply)
:
Copy (Text,
Word, existing site, etc.)
Images
and graphics
Design
layout
Site map
No materials
will be provided
Other (please
explain in the text fields below)
Please
estimate the number of pages
you will need.
:
pages
1
- 5 pages
5
- 10 pages
10
- 20 pages
20
- 50 pages
50
- 100 pages
100
- more
When
is your project start date?
:
Immediately
In
two weeks
In
one week
In
two months or longer
Competitive
Analysis & Design
(If
possible, provide examples
of Web sites that you like
and why and the web sites
of your main competitors.)
:
How
did you hear about Mirackle
Web Design?
:
how
did u hear about us
Google
Yahoo
AOL
7Search
MSN
Dmoz
Look
Smart
Ask
Jeeves
Word
of Mouth
Requirements
(Please
describe your requirements
in as much detail as possible,
e.g. if you need a web site
developed then describe its
purpose, audience and any
features like eCommerce or
databased content etc)
:
Choose
payment option?
:
Payment
option
Credit
Card
Demand
Draft
Check