Web Site Design and Development Needs Assessment

Please complete and submit the form below:
Contact Name:*
Title:
Business Name:
Address:
City:	State: Zip Code:
Phone:	-- ext. Fax: --
Email Address:*
Industry:	Other:
Web site Address:

What is the purpose of this web initiative? Check all that apply.
Establish an online presence Provide public information Provide private information Sell products online (eCommerce) Offer customer service Create a virtual community Intranet for organizational process support Content Management Not Sure	Increase marketing and product branding Increase Sales Generate Business leads Increase international presence Support existing advertising, promotional efforts Build Business Traffic Provide latest information Survey customers/prospects Other (please specify)

What services are you seeking? Check all that apply.
Domain Name Registration Web Hosting provider Web site Design and Development Web Redesign for better look, feel, functionality Content Writing Stock Photos and Images Custom Photos and Images Web Video, Flash Elements, Web Audio	Graphic Design (web image, logos, etc...) Search Engine Submission Internet Marketing and Promotion Strategic Marketing and Promotions Web site Maintenance Improved Search Engine Ranking Consultation Other:

Which common pages does your site need? Check all that apply.
About Company Portfolio of Work Contact Us Press Releases Quote Request Form Products	Testimonials Facility Information Customer Service FAQ Services Newsletter sign-up	Online Registration Management Bio Event Calendar Employment/Careers
List any other pages your site will need:

Web Site URL	Description of Feature/Designs
List web sites with Features/Designs you want your site to include:

List your competitor's web site addresses:

Who is your target audience(s)?

What are your timelines for consultation, design, development and launch?

What is your estimated project budget?

Any additional information that will need considered?

Note: Upon submitting the form, you will be taken to the BRL Consulting Home Page.