For quality web site development, please complete the form below. Though the fields in section 1 represent the minimum required information, please understand that the more information provided, the better the web site! * Denotes a required field Phone Design and development fees for the First 5 Pages are included in membership fees for all USMCA members First Name * Last Name * Email Address * Must be a valid email address. Phone where you can be reached * Business Name * Business Phone 1 * Phone 2 Fax Full Address of Business * City * State * - Select Province/State - Alberta British Columbia Manitoba New Brunswick Newfoundland and Labrador Nova Scotia Northwest Territories Nunavut Ontario Prince Edward Island Quebec Saskatchewan Yukon ==================== Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Zip * Describe your business in a sentence or two. * Interview Date * Please indicate the best possible day and time to have a 15 minute phone interview with your developer. - - Do you currently own a web site? own web site Yes No If yes, what is the location of your website? Location of current web site? Do you currently own a domain name? (for example: www.my-website.com) need domain name Yes No If you currently own a domain name that you wish to have applied to your new web site, please click this text for directions to effect the transfer. If no, what would you like to use as a domain name for your new website? domain name 1 second choice -domain name 2 1) Do you have a company logo or business cards? logo Yes No 3) Do you have prepared content for your website in the form of brochures, flyers, company profile, resume, pdf's etc? content Yes No 2) Do you have particular images that you would like included on your web site? images Yes No Have you owned a website at any time in the past where materials can be retrieved? owned in past Yes No If you answered yes to questions 1, 2 or 3 above, please forward these materials electronically by clicking below. (Original artwork is preferred.) upload CLICK HERE TO UPLOAD IMAGES As a web developer I provide skeleton content for your website allowing you to flesh each page out if necessary. Would you prefer a professional content writer to assume this task? (Depending on the scope of work charges generally run from $100 to $500.) Would you like professional content written to your web site? What are your hours of operation? business hours What slogan(s) or tagline(s) do you use? Slogans and Taglines Please provide your NAICS or SIC code if available: NAICS and SIC codes Are you licensed and insured? List Licenses/Insurance Provide a welcome page message promoting your business and/or describing your services. Type message here What industry-specific keywords would you expect an Internet surfer to use in a search engine to find your business? keywords How did you hear about us? Source of Information How long have you been in business? Years in business: List the services you offer: List services here : How does your company excel or what makes your business superior to your competitors? We excel because What are your certifications? List certification here : Would you like to use an industry-specific music loop on your website at no additional charge? Music loop Yes No Additional comments or instructions: Instructions When would you like the work to be completed? Date Standard cost for web site hosting is $35/mon. This fee is required of all USMCA members and includes the following services: *Please Note: Inadequate hosting services severely impacts the performance of a web site on the Internet. It also results in poor search engine rankings and limited exposure to your target audience. For more information on virtual private hosting please visit the web site at www.hostgator.com/hosting OR www.godaddy.com/hosting Please indicate below which hosting payment option you prefer Hosting payment options 1) Auto Bill Pay 2) Electronic Credit Card 1) Auto bill-pay -- Preferred method. Your bank is notified to submit regular payments on the 1st of every month. Simply provide your bank with the following information: Creative Business System PO box 313 Mt. Vernon Illinois 62864 2) Electronic credit card payment using a Credit Card can be set up to auto process payment each month. No Debit Cards are accepted When your first month's hosting is received you will have 30 days to make any revisions or changes needed at no additional charge. Credit Card only. No Debit Cards accepted Name on Credit Card CC Number Expiration CVC Code Zip Code Only click the submit button once.