Web Page Development and E-Business  Assessment Form

Business Information:

What type of business do you perform (select all that apply - Ctrl+Click For Multiple Selections)?

General Retailer (e.g. Grocery store, video store, etc.) Specialized Retailer (e.g. Health Products, Hobby Store, etc) Other Retailer Entertainment (e.g. Video Rentals, Restaurant, Bar, etc) Educational (e.g. Karate school, golf instruction, foreign language school, etc) Business Services (e.g. Consultant, Accountant, etc.) Other Services *

* If you selected "other services" please, specify:

Consumers Small Business (Companies with less than $10 million in annual sales) Middle Market Companies (Companies with annual sales between $10 and $50 Million) Large Corporations (Companies with annual sales in excess of $50 Million)

How many employees do you have?

1 - 5 5 - 20 20 - 50 50 - 250 250 +

How long have you been in business?

Less than one year One to three years Three to five years Over five years

What is your current geographical target market (select all that apply - Ctrl+Click For Multiple Selections)?

South Florida Florida Southeast States Other States * Latin America * Caribbean * Asia Europe * Canada

* Please list countries in the space provided below:

Does your competition have Internet Web sites?

Yes, some of my competitors have a web site * Yes, all of my competitors have a web site * No, none of my competitors have a web site Do not know

* Please list Web site addresses for any competitors:

How do you promote your business (select all that apply - Ctrl+Click For Multiple Selections)?

Yellow pages Newspaper Radio T.V. Direct Mail Flyers Telemarketing Direct sales force Sales agents Other *

* If you selected "other" please, specify:

What are your annual sales?

Less than $500,000 per year $500,000 to $ 2,000,000 per year Over $2,000,000 per year

What sales growth have you experienced over the past 12 months?

None - Sales remain at a constant level Sales have grown less than 5% over the past 12 months Sales have grown between 5% to 9% in the past 12 months Sales have grown between 10% to 25% in the past 12 months Sales have grown over 25% in the past 12 months

What is your goal with the Internet (select all that apply - Ctrl+Click For Multiple Selections)?

Promote my company via the Internet Sell goods over the Internet Sell services over the Internet Expand into a new geographical market through the Internet Provide product/services information over the Internet Provide customer service/product assistance over the Internet Other *

* If you selected "other" please, specify:

Please list any special Internet applications you’re interested in looking into in the future?

Please list all of the search keywords that you feel match with your website content and should be listed with the Internet search engines; such as Yahoo, Excite, etc.

Please provide a general idea of the desired Web site theme or look and feel.

Please provide any desired web site color combinations.

Please provide list of desired website links in your website such as related industry/country links for website users.

Please provide usernames for Web site email contacts.

Would you be providing any graphics materials that you would like included in your website; such as pictures, logos, etc (We will scan photos and art work if necessary).

YES NO

Please provide information for a request/feedback form information fields/data.

Do you have a Domain Name registered?

YES * NO **

* If YES,  

What is the Domain Name?

When was it register?

When is it up for renewal?

** If NO, would you like for us to find available Domain Name combinations?

YES * NO

* * If you selected "YES" please, specify:

Do you have an Internet Service Provider for hosting you Domain Name?

YES * NO **

* If YES,

Company name?

Contact name?

Contact E-mail Address?

Phone number?

When is your service/plan up for renewal?

** If NO, would you like for us to advise of new services/plan options?

YES NO

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We thank you for your time in completing this Web page development and e-business assessment form.