Contact form to request formal project proposal

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Company / Organization Information (Required)

Company / Organization Name:
Street Address:	Please include unit designation, if any.
City:
State:	2 letter format, please.
Zip:	5 digit zip, please.
Contact Name:
Contact E-mail:	Please verify for accuracy.
Contact Phone:	Please include extension, if any.
Which service(s) are you most interested in? Please check all that apply.
Research Design Local SEO eCommerce	Website Promotion Website Maintenance Website Analytics / Metrics Other

Company / Organization Information - Continued (Optional)

Current Website Address:
How did you hear about JaCorWeb?
Please describe your company or organization, the nature of the business or service performed, and a brief overview of where the idea came from for developing the website/project. Also include a description of any competitors in the industry and how they and their efforts compare.
What is the full scope of your project?	Select an option New Project Full Redesign Partial Redesign Site Updates Location Transfer Other
What is the primary goal of your project?	Select an option Marketing Streamline Business Process Sales Community Entertainment Other
Are there any planned features or functionality?	Select an option Yes No Undecided
What do you perceive as your greatest challenges / obstacles?
How will you measure the success of this project? How will it pay for itself?
What is the timeline for this project?	Select an option Less than 1 month Between 1 and 2 months 2 to 4 months More than 4 months
When will you select a vendor?	Select an option This week This month This year
When will the project launch?	Select an option 2009 2010 2011
When do you want the project to finish?	Select an option 2009 2010 2011
Is there anything driving the launch date?
What is your budget?	Select an option Under $5,000 Around $8,000 Around $12,000 Above $15,000

Process (Optional)

Please provide the following information regarding the project manager:
Project Manager's Name:
Project Manager's Phone:	Please include extension number.
Project Manager's E-mail:	Please verify for accuracy.
What is the process for gaining approvals, sign-offs, etc. for this project?
If this project involves significant content updates and / or maintenance, is there a process in place to handle these actions?
How and where will the content be generated?

Market / Brand Identity (Optional)

Logo Colors	Marketing / Collateral Samples Usage / Participation Guidelines
other:
What are your company's position, mission and vision statements?

Technical (Optional)

Are you currently using any type of back end system?	Select an option Yes No Unknown
Do you have any plans for changing or updating this system?	Select an option Yes No Undecided
Are there any legacy systems or databases that need to be integrated with your project?	Select an option Yes No Unknown
What is the expertise of your in-house technical group?	Select an option Novice Intermediate Advanced
If you have an existing online presence, how is it hosted?	Select an option SSL Dedicated IP Shared Hosting Dynamic IP Unknown

Target Market / Audience (Optional)

Who is your primary target market(s)?

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our physical address

JaCorWeb
1552 Helderberg Avenue
Suite 14
Rotterdam, New York 12306

Phone: 518.577.0979
Fax: 518.399.6153