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Please print out and complete the form below. Then, either fax it back to us (703-533-2934) or bring it with you to your first consultation.

Name of Website contact ___________________________________

Company/Organization _____________________________________

Address _________________________________________________

City/State ____________________________________Zip_________

Phone inc. area code _______________________________________

Fax _______________________ Alt. phone ____________________

Email address ____________________________________________

1. Do you currently have a company website? Yes No
If yes, what is the address? __________________________________

2. Why do you want a [new] website? (all that apply)

a. We've outgrown our current site.
b. We have needs that a new site could potentially fulfill.
c. We have money now that we didn't have to spend on a site before.
d. We want to join other companies on the Information Superhighway.
e. Other: ___________________________________________

3. What is the main purpose for a website? (one best answer)

a. Providing information to our clients and potential customers
b. Meeting our market where it lives (marketing)
c. Selling online
d. Other ____________________________________________

4. What kind of "stuff" do you want on your site? (all that apply)

a. Mouseovers
b. Animation
c. Moving graphics/words
d. Specially designed graphics
e. Other ___________________________________________
f. Huh?

5. How much do you expect to spend on a site? (one best answer)

a. Under $500
b. Up to $2,500
c. Up to $5,000
d. Up to $10,000
e. Whatever it takes
f. Other ____________________________________________

6. What are some of your favorite websites? (please provide URLs)

P.S. How did you hear about 3rd Wave?

Thank you for taking time to take this quick survey. Now, we'll be better able to help you.