MEDIAWORLD CORP. CLIENT SUPPORT FORM
Please fill in as much as you can.
If you're in the Metro NY area, we would prefer to
arrange a meeting to discusss your needs.
Please call us.
This form will give us a better idea of your needs
and some preliminary information before
we discuss your project further.
MediaWorld Corp. does NOT share or sell any information.
Yes, this form is long. We're very thorough.
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for our short form.
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*
Required fields
*
Name:
*
E-mail Address
:
Phone
Best time to call?
Select
Early Morning before 8:00AM
Mornings
Afternoon
Late Afternoon after 5:00PM
Evenings up to 9:00PM< /option>
Weekends
Do Not Call
I'll call you
e-Mail only
Fax only
I don't have a phone
I have to ask my wife.
I have to ask my partner
Call who?
Don't Have A Clue
Website Address:
(If you have one)
How did you get to our site?
Select
Existing Client
Referred by a Friend
Former Client
Search Engine
Google Ad
Yahoo Ad
Link from another site
Link thru a Blog
Sheer Luck
Online Classified
Beamed Here
Cruise Ship
Bus
Taxi
Don't Have A Clue
Please provide the following information.
I am interested in the following services you offer:
(Other services
available. Please ask.)
Website Design
Shopping Cart/Order Form
Domain Registration
Secure Website Hosting
e-Mail Server Only
Database Development
e-Consulting Services
Website Re-Design
Website Promotion SEO
Periodic Website Maintenance
Other Service (Please Explain below)
Price Range:
Select
$100 - $300
$300 - $500
$500 - $1000
$1,000 - $2,000
$2,000 - $3,000
$3,000 - $5,000
$5,000 - $10,000
$10,000 - $15,000
Other
Purpose of the web site:
e-Commerce
e-Information
Fund Raiser
Select a Category for the web site:
Select
Small Business
Personal/Family
Non Profit
Religious
Real Estate
Government
Computers
Entertainment
Finance
Insurance
Jewelers
Dating Service
Other (Explain Below)
Who is your target audience?
Will you supply images?
Yes
No
How many Images?
Select
1 - 2
2 - 4
4 - 8
8 - 12
12 - 20
20 - 30
30 - 50
50 - 80
80 - 120
120 - 200
More
Will you supply text?
Yes
No
Do you have a Logo?
Yes
No
Do you need us to
create your Logo?
Yes
No
Do you have inventory (e-Commerce)
Yes
No
If Yes, is it in Excel format?
Yes
No
Do you need us to convert your Database into Excel?
Yes
No
What special features would you like to include?
GIF Animation
Flash Animation
Interactive Forms (Feedback or Survey)
Newsletter
Calender
Calculator
GIF Animation
Sound
Video
Chatroom
Client login
Guest Book
Banner Design
Shopping Cart
Domain/Hosting Information
Do you currently have hosting for your web site?
Yes
No
Do you currently have a domain name?
Yes
No
Please add any additional comments you would like to make.
Thank You for your time.
Email:
info@MediaWorldCorp.com
MediaWorld Corp.com
For Immediate Service call: 631 665-4200
Form MWC-sf2
Copyright 2006-2007 MediaWorld Corp.