Simplex Services

Cost Proposal Form

Please Provide All Pertinent Information

Contact Information

Your Name:
Company :
Your Email:
Present URL:
Address :

City :
State :
Zip :
Your Phone:
Your Fax:
Best Contact Day :
Best Time:
Best Way :

How did you first hear about us:

If you chose "Other" above, please explain:

Inquiry Purpose

Which services would you like an Estimate for or how may we help you?


The following questions will help us get to know you, your company and your needs. Please give us as much information as possible.
What is the nature/purpose of your business?

Does your Company have a Motto or Mission Statement?

What Products/Services do you offer?

What makes Your Company Special?

Who is your Target Market?

What role will the Internet play in your business plan?

How do you expect Internet marketing to effect your business?

How do you envision your company on the Web?

What other Web sites have you visited and liked?

What did you like about them?

Type of Internet Access & WWW Browser?

Do you have server storage space for your web pages? Yes, I already have a site.
Yes, but I'm not sure if it's right.
No, I'll need your help.
No, I'll only do mall-type advertising.

Have you registered a Domain Name yet? Yes
No, I'll need your help.

Do you use a Company Logo & other artwork?Yes
No, I'll need your help.

How many web pages do you need (including the home page)
Do you plan to use online product ordering?Yes

Do you want to use online forms?Yes No

How many forms & types will you need? (survey, guestbook, quote, order, etc.)

Do you have a catalog or brochure?Yes No

Do you need an E-mail Auto-responder?
Yes, I need an Autoresponder
No Autoresponder is Necessary
What is an Autoresponder?

How many A-R's ?

Are there any special needs you might have?

Is there anything else you'd like to tell us?

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