


Name of Company:
Street Address:
City:
State:
Zip Code:
Telephone:
E-mail:
Your Name:
Your Title:

Why do you want a Web site?
	To sell a product or service
	To provide information
	To secure information
	To entertain
	To educate

How many pages do you want?

Will you provide the site's content (text, photos, logos)?
	Yes
	No (NetPeers will develop)

Will your site require data base capability (ie. shopping carts, etc.)?
	Yes (additional hourly fees will apply)
	No

Which of the following features are you interested in (no additional charges apply)?
	On-Line Customer Order/Inquiry Forms
	Links to other Web sites
	Scrolling Marquees
	Rollover Buttons
	Slide Shows
	Animation

Do you already have a Internet Service Provider who will host your Web site?
	Yes
	No (NetPeers will provide one)

Is there a deadline for completion of your Web site?
	Yes
	No
	If yes, what date?

Do you have any questions or comments for us?


Where did you learn about NetPeers?
	Word of Mouth
	Yellow Pages
	On the Web