| Title |
Mr Mrs
Ms |
| Surname |
|
| First
Name |
|
| E-Mail
Address |
|
| Job Title
|
|
| Company /
Organisation Name |
|
| Contact
Address |
|
| Telephone
No |
|
| What does your
organisation do? |
|
| Current Computer
System |
|
| Current Operating
System |
|
| Preferred
Browser |
|
| What
are you looking for in a web site? Please give an idea of your vision, with the
approximate number and type of pages you require. |
|
| Interested in Hosting package? |
YesNoDon't Know |
| Interested in Management Plan? |
Silver Gold
None Platinum |
| Do you want
E-Mail? |
YesNoDon't Know |
| Do you want your
own Domain Name? |
YesNoDon't Know |
| Are you confident
with the Internet? |
YesNo |
| Will you require
training? |
YesNoDon't Know |
| Will you require
support? |
YesNoDon't Know |
| |
|