Web Site Partner
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Member Information Request

For businesses interested in web site consulting services. Please complete this short questionnaire and provide your contact information below to receive more information about how to get started as a member.

 Why are you interested in having a successful web site for your business? (select all that apply)
 

Rate the following items in terms of their importance to you in choosing a web site consultant:
<<1 = Least Important ------------ Most Important = 6>> 1 2 3 4 5 6
 Help with getting started and determining needs
 Help creating initial web site content and design
 Help with future web site updates and changes
 Help and advice with web site marketing
 One monthly price for ongoing support
 Email and phone support always available
 Face to face support available by appointment
 Training to allow you to update your own web site

Rate the following items in terms of their importance to you regarding a web site for your business:
<<1 = Least Important ------------ Most Important = 6>> 1 2 3 4 5 6
 Professional and attractive visual design
 Easy to use and navigate the web site
 Compelling, useful and up-to-date content
 Easy to update and change by yourself
 Customers can easily find your web site
 Fast loading and always available for visitors
 Custom design unique to your business
 Ability to promote/sell products and services
 Ability to communicate with customers

Rate the extent to which you agree with the following statements about the Web Site Partner service:
<<1 = Strongly Disagree ------- Strongly Agree = 6>> 1 2 3 4 5 6
 I understand the service and how it works
 I like having a partner always available to help me
 I like having one monthly payment for all services
 I think this service would suit my web site needs

 Based on what you know about the Web Site Partner service, what do you like MOST?

 Based on what you know about the Web Site Partner service, what do you like LEAST?

 I would rather have a payment option where I:

 I would rather have a start up cost where I can:

How likely you would be to get started in the Web Site Partner service at each of the following costs:
<< Please select an answer for each cost >> Definitely Probably Probably Not Definitely Not
 $149 per month with $0 up front cost
 $129 per month with $0 up front cost
 $99 per month with $0 up front cost
 $69 per month with $0 up front cost
 $49 per month with $0 up front cost
 $99 per month with $499 up front cost
 $69 per month with $999 up front cost
 $49 per month with $1499 up front cost
 $29 per month with $1999 up front cost
 $19 per month with $2499 up front cost

Rate your level of skill/experience in the following categories:
<<1 = Very Low ----------------------- Very High = 6>> 1 2 3 4 5 6
 Computer Operations
 Internet Use / E-mail
 Internet Sales and Marketing
 Website Design / Development

Please tell us a little about your business and current web site (if applicable).
 Type of business:
 Number of employees:
 Business market - local, regional, national, or international:
 If you currently have a web site, how satisfied are you?
 If you currently have a web site, how important is it to your business?
 If you currently have a web site, approximately how much do you pay per month?
 If you currently have a web site, approx. how much did you pay to have it created?

Thank you, please include the following information and we will contact you as soon as possible. Your responses will remain completely confidential and we will never disclose your personal information to anyone.
 Business Name:
 Contact Name:
 Email Address:
 Phone 1:
 Phone 2:
 Fax:
 Address:
 City:
 Zip Code:
 State/Prov:
 Country:
 Comments: