Website Design Intake Form Business Name(Required) Business Email Business Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Business Days & Hours of OperationPrimary Goal and "Calls to Action"Business Type Business (B2B) Consumer (B2C) Does a new logo need to be created? *additional cost Yes No Do you have logo(s) in digital format? (e.g. jpg, psd, ai, eps).If yes, please attach high resolution image(s) of your logo(s) below.Max. file size: 128 MB.Do you have a branding manual?If yes, please attach the branding manual below.Max. file size: 128 MB.Images of your business activities.Please attach as many high-resolution images as possible that you think the creative team can use to promote your business.Max. file size: 128 MB.Business Colour(s) Primary Colour Seconday Colour(s) Complimentary Colour(s) Colour(s) to Avoid What are the conversion goals of your website? Phone Call Download of Document Form Submission Specific Page Purchase Select AllWebsites ExamplesList a minimum of 3 websites below and identify the elements that you like/dislike about them. Think of color, style, fonts, layout, etc. These elements will guide the team to match the look and feel you're aiming for.WebsiteElement Details Add RemoveAre you going to use existing content for the website? Yes No Are you going to create new content? Yes No Do you need copywriting service? *additional cost Yes No Will there be a video on your website?If yes, please describe the source (file or URL) of the video. Hosted in your own site Hosted in YouTube and inserted into your site No Do you have an existing business website? Existing Business Website Username Existing Business Website Password Do you have a domain registered? Yes No Do you have access to domain administration? Yes No Domain Registrar Domain URL Domain Username Domain Password Do you need hosting service for your website? Yes No If no, where will the new website be hosted? Hosting URL Hosting Username Hosting Password Does your current website have a content administrator?(e.g. does the administrator allow you to change/update/delete content without the supplier assistance) Yes No Facebook URL Instagram URL Twitter URL Pinterest URL LinkedIn URL Other URL
