Special Offer

Customer Information

Your Name

Telephone

Address

City State

Zip Code

E-mail address

Fax

Company Information

Same as above? Yes

Company Name

Company Address

Phone

Fax

E-mail address

What is the purpose of this business?

What is your companies' product or service?

Please list three unique benefits of your product or service:

Vision / Mission

This company was founded in (year) .

The companies key strengths are:

What is the key message or phrase to describe your business in one sentence?

What is your reason for starting your own business? What led you to develop your product?

Who is your target audience?

Who is your competition?

How is your product differentiated from that of your competition?

What is the pricing of your product versus your competition?

Are you making any special offers?

Company Identity

Please indicate any colors used to identify your company, as well as any tag lines,
themes, and/or images. Feel free to e-mail me with photos, logos and/or drawings
that you feel would represent your company and its goals.

The Following Questions Pertain to Web Site Design

Yes, I have a domain name

No, I do not have a domain name
1st choice for Domain name
2nd choice for Domain name
3rd choice for Domain name

Yes, I have a Web Host
No, I do not have a Web Host

Web Keywords

Please list approximately 25 keywords which describe your company.
These keywords are used to draw people to your site.
These are words that people enter into search fields when searching the internet.
These keywords are a way of referencing your business online.
Examples: Chicago, marketing, clothing, trade, woman-owned, African-American.

Goals of Web Site

Please write a brief summary indicating your goals, plans and/or expectations for your web site.

Web Site Features

Please indicate which of these items you would like to include on your site,
and if you will be supplying any of these items.

Animation I Will Supply
Flash Content I Will Supply
Banner Ads I Will Supply
Shopping Cart I Will Supply
Links Page I Will Supply

Clip Art I Will Supply
Photos I Will Supply

Guestbook I Will Supply
Hit Counter I Will Supply
Order Form I Will Supply

Streaming Audio I Will Supply
Streaming Video I Will Supply

Any other Suggestions, Ideas or Special Requests

The customer acknowledges that Simone Bouyer's Ad World Services does not own or control the various telecommunications facilities to which it may provide access, except those specifically identified as belonging to Simone Bouyer's Ad World Services.

Simone Bouyer's Ad World Services shall receive a credit line with an active weblink on the first page created for the customer. Simone Bouyer's Ad World Services is not responsible for domain name requests that have been issued to another company/individual prior to this request. Trademark issues are the sole responsibility of the customer.

THE CUSTOMER AGREES THAT SIMONE BOUYER SHALL NOT BE LIABLE FOR ANY LOSS OF PROFITS, LOSS OF USE, INTERRUPTION OF BUSINESS, OR ANY DIRECT, INDIRECT, INCIDENTAL OR CONSEQUENTIAL DAMAGES OF ANY KIND resulting from the Customer's use of Simone Bouyer's Ad World Services, equipment, the Internet or otherwise. Use of Simone Bouyer's Ad World Services or equipment constitutes acceptance of this Agreement in full.

Use of the Internet and the information contained therein is at the Customers own risk.

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