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Webvertise Information Worksheet


      Thank you so much for the opportunity to work with you and your company. Please take time to fill out the  information worksheet, which will assist us in working with you better. After review of your information, we will present to you the cost for your website. Our prices can range from a simple one page site with no pictures for $50.00 to a multi page site with multimedia and database integration for over $1000.00.  Please feel free to contact us at anytime if you have any questions. Thank you.


Text versions to print and fill out later

Customer Information

  • Please provide the following contact information:

    First Name

    Last Name



    Type Of Business/Organization

    Street Address

    City, State, & Zip




    Site Information

  • Do you currently have a site?  Yes No

  • Do you have a logo?               Yes No [Upload your logo quick and easy using these instructions]

  • Do you have a domain name?  Yes No

  • If yes, then what is the name?


  • What is your desired website name and extension?  [Tell me more about this...]


    1. www.name.com  

    2. www.webvertise.us/name (Using our server - Lower price)

    Choice  -1

    Choice - 2

    Choice - 3

      Use our search tool below to see if the domain name you want is available:



  • Are there any sites that appeal to what you'd like?

    Site - 1

    Site - 2

    Site - 3

    Site - 4

    Site - 5


  • Select the following options that you would like your site to contain:

    Guest Book

    Discussion Board

    Chat Room
    Hit Counter

    Photo Gallery [Upload your photos quick and easy using these instructions]
    Online Forms
    Feedback Form
    On-Line Shopping

    Splash/Flash Intro Page

    Online Payment Acceptance [If you do not have a PayPal account get one here FREE]

  • How many pages would you like your site to contain?


  • What titles would you like for each page?

    Page - 1

    Page - 2

    Page - 3

    Page - 4

    Page - 5


  • What is the budget you are working with for your site?

  • How did you hear about us?  


  • Enter the date of that you would like your site completed and operational (mm/dd/yyyy)

    Maintenance Plan

  • Which update plan would you like to use?

    Add any additional comments or specific information needed to create your site.

    When we receive your information you will receive a confirmation.


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