DELUXE WEB DESIGN QUESTIONNAIRE About Your Company Your Name * Company Name * Your Email Address * Current Website Address Address * Address Address Address Address Address Address Country AfghanistanAland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBruneiBulgariaBurkina FasoBurundiCôte d'IvoireCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCook IslandsCosta RicaCroatiaCubaCuracaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland Islands (Malvinas)Faroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestinePanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarReunionRomaniaRussiaRwandaSaint BarthelemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint Martin (French part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint Maarten (Dutch part)SlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUnited States Minor Outlying IslandsUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe Country Telephone * Cell Phone * Years in Business * What forms of payment do you offer? (Please check all that apply) * Visa Master Card Amex Discover Paypal Cash Check Financing Hours of Operation * Design Preferences Company Colors * Are there any colors / designs you DO NOT want to see in your new website? Are there any websites that you’ve seen or styles that you’d like to incorporate into your new website? * Preferred Navigation Style * Horizontal Vertical No Drop Down Menus Navigation Text - Please tell us what pages/order you would like in your menus * About Your Current Marketing This information will help us to cater your new design to your services & your service areas. In addition, connecting your Google account to your new site is crucial! When we finish setting up your website, we will use this login to connect your analytics, webmaster tools, as well as submit a new sitemap to Google. Google Email Address * Google Account Password * How far do you travel? Please list your main service areas. * Please list ALL the services you offer. * Information for Your New Website Please list any Awards/Associations/Links that you would like to include: How much of the existing content would you like to bring over into the new website? Please be specific about pages you wish to drop/add. * Do you want us to write your website text for you? * Yes No We can professionally write optimized, unique content for your site! This service will add an additional payment to your current selection. Confirm that you DO want to add an additional payment to your plan for professional copywriting: * I am aware there is an additional payment for Professional Copywriting. Nevermind, I do NOT want to add copywriting. Additional Details Who manages your domain? Please provide the Login Id & password for us to access your hosting account: Dropbox Info Please upload a logo file to use: Drop a file here or click to upload Choose File Maximum file size: 134.22MB For files up to 2 MB. If your logo file is larger than 2 MB, please wait and use our project manager or Dropbox to share your logo with us. Additional Items If you have before and after photos, pictures of your team on site, photos of your office, photos of your staff, etc., PLEASE use Dropbox to send them to us. Our company dropbox account is info@21stcenturywebdesign.com. Some Other Items You Might Consider Sending: Customer Testimonials Printed Advertising Media (brochures, flyers, etc.) Page Text (if different from current website text) Terms & Conditions By submitting this, you acknowledge that you have read and agree to our TERMS & CONDITIONS. You will receive a copy of our terms and conditions via email upon submitting this form. WHO WE ARE 21st Century Web Design Palm Bay, FL 32907 (321) 723-6945 www.21stcenturywebdesign.com Hours: Monday - Friday 9:00 am - 5:00 pm $-$$$ WHAT WE DO Web DesignInternet MarketingLogo & Print DesignTerms & Conditions READ OUR BLOG Is SEO Still Relevant in 2024? Website Launch Alert! – Why Food Works 4 Keys To Effective Web Design CONNECT WITH US