Web Design Intake Form Please enter as much information below as you can. What do you want to accomplish with your new website:* What types of pages do you want on your website?*Do you have a domain name?*Where did you purchase your domain name?*(we will need access to update this in the future)Do you have or require website hosting?*(we offer website hosting $19.97/mth, which comes with Free SSL and weekly backups)What email platform do you use?Example: (go daddy, telus, business gmail, outlook)Do you have specific branding or are you open for change?*Example: (logos, colours, a look that's different from your promotional materials)Do you need special features on your website?Example: payment processor, bookings, donation box, lead forms etc.Do you have any examples of other websites you would like to replicate?Do you have written content for your pages?*(at least 300-400 words per page) We do offer content writing services for an extra charge.Do you have pictures (high quality) for your website?*(we offer 5 stock photos or a photography service)Do you have any videos for your website?Business InformationCompany Name:* Business Address:* Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCรดte d'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe Country Business Phone:*Fax: (IF)Toll Free Number: (IF)What email service do you use?Example: Go Daddy, Gmail Business, Outlook, Telus etc.Profile Email / Web Mail / Business Email: (IF) Business Type / Category:*Products / Services:*Business Hours:Example: (Mon-Fri 8:30-4:30, Sat 11:00-3:00, Sun Closed)Payment Methods Accept [Highlight all that apply]:* Cash Cheque Debit Card Visa Master Card American Express Discover Diners Club PayPal Invoice Financing Travelers Cheques Euro Card In Business Since:*Business Description - Short (200 Characters Max):* Business Description - Long: Business Logo: Upload HereAdditional InformationTag Line / Business Slogan: (IF)Specialties (exclusive products, areas of expertise): (IF)Cities Served / Counties Served / Areas Served: (IF) Brand Names Carried: (IF)Social Media Page URLs (Face Book, Twitter, Blog): (IF) Owner InformationFull Name* First Last Contact Number:*Owner / Contact Person Gender:MaleFemaleAny other questions or features? (mention it here)