Please provide the following contact information:

Best time to reach you by phone

Morning
Afternoon
After Hours

Do you currently have a web site?

Yes
No

If yes, what is the URL?

If yes, how long have you had your web site?

Less than 6 months
6-12 months
1-2 years
2-5 years
Longer than 5 years

If yes, do you have a Webmaster on staff?

Yes
No

What primary products and/or services do you provide/
Tell us what your company does?

Describe your current needs. Select any of the following 
options that apply:

New complete website
New commercial e-commerce enabled website
Existing site needs redesign 
Domain Name Registration                 
Web Hosting
Consulting
Search Engine Optimization
CD ROM Presentation                      
Web Marketing                              

What is the purpose of your site? Select any of the 
following options that apply:

Internet Presence 
Attract local customers
Broaden customer base
Convey a corporate image                                               
Provide information
Sell a product online
Advertising products and/or services
Collect user demographics                                                    
Publish a newsletter
Other
                  

What is the volume of products/services applicable?

0-10
10-20
20-30
30-40
40-50
More than 50

Describe your target web audience:

How do you plan on incorporating your web site with 
your traditional offline marketing and communications?

How many pages do you anticipate for your site?

Nil-10
10-20
20-30
30-40
40-50
Above 50

I prefer:

That MDI built my initial site and I will mange it from 
there
A custom site built and maintained by MDI

What services will your site need to provide? Select any of 
the following options that apply:

Contact request or info form
Streaming video and/or audio
Company profile
Logo, banner or other graphic design
News/Announcements
Flash intro or other animation
Bulletin board/forum
Map and driving directions
Classified Ads
Product pages featuring products
Photo gallery featuring photos
General information/FAQ
Newsletter/Mailing list
Downloadable/Printable documents
Employment details
Secure online credit card processing
Events calendar
Advanced navigation
Password protected user areas
Informational/promotional popup
Shopping card featuring products

Do you need content written for your site?

Yes No

List 3 competitor websites and what you like/dislike about 
them:

What are the short term goals of your site?

What are the long term goals of your site?

When would you like to have this project completed?

Less than 2 weeks
2-4 weeks
1-2 months
3-4 months
5-6 months
6 months or more

What is the range of your annual budget?

Undetermined
Less than R2000
R2000-R4000
R4000-R6000
R6000-R8000
R8000-R10000
R10000-R15000
Over R15000

When do you need this proposal by?

No more than 2 weeks
Within 1 week
Within 4 days
Within 2 days

How did you find us?

Google
Alta Vista
Overture
Ananzi
Aardvark
AOL
MSN
Yahoo
Other search engine
Web Link
Newspaper
Phone Book
Word of Mouth
Other

THANK YOU FOR YOUR VALUABLE TIME