Client Information

Order Number *
Representative *
Date *
Client Name *
Business Name *
Address *
City *
State *
ZIP Code *

Phone *
Fax *
Email *
Website URL *
Contact Name *
Position *
Email Address for Contact Box on Website *
Address for Website *
If multiple addresses or additional info please include below: *

Type of work requested :*
Website Basic Website Advanced Wordpress Website Basic Wordpress Website Advanced Website Makeover Flash Site Joomla	Facebook Fan Page E-Commerce Reputation Management Social Media Logo Design Content Development Review Package	Online Forms Landing Page Referral Slip Hosting Package Email Package Domain Security Certificate	SMS Service SEO Package Pay per Click Others (Explain)

Questionnaire on Work to Be Preformed

Does the client currently have a Hosting?*

Yes No Unsure

If yes, please please indicate details about current hosting company.

Name :

Username :

Password :

FTP Info :
Username :

Password :

Will the client need hosting?*

Yes No Unsure

Does the client currently have a domain name?*

Yes No Unsure

If yes, please indicate details about current domain registrar.

Company :

Username :

Password :

Does the client need to secure a domain name?*

Yes No Unsure

If yes, please please indicate the name(s) needed.

If you're unsure if a name is available please visit www.gizoom.com and click on hosting and domains to check availability.

If the client has a domain already, do they want us to manage the domain for them?*

Yes No Unsure

If yes, please indicate domain registrar information. (We will begin transfer prior to site being completed unless prior discussion.)

Company :

Username :

Password :

Does the client have a logo?* Yes No Unsure

If no, do we need to create logo?*

Yes No Unsure

Miscellaneous Information*

Website Marketing Information

KEYWORDS

Please list 10 keywords that would best represent your web site in search queries.*

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NEGATIVE/EXCLUDED KEYWORDS

Please list 10 keywords that would NOT represent your site properly or you would NOT like to be found under in a search query. Successful advertisers understand how they DO want to be found and how they DO NOT. *

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COMPETITOR NAMES AND THEIR WEBSITES

Please list 5 competitors and the web sites we need to research to better understand your market and target audience. *

Name
Name
Name
Name
Name

Website
Website
Website
Website
Website

PRODUCT/SERVICE INFORMATION

Please list all major product/service categories. *
What is the most critical function of your company? Why do you believe your site and offerings are better than your competitors' sites and offerings (e.g., you offer free shipping, a wider selection of product X, expert advice, better site search, etc. What are your customer segments? Objectives? *

TECHNICAL INFORMATION

Is there a current tracking system in place for the medium we are working on? *

Yes No Unsure

If yes please describe how we can access tracking system to determine conversions, revenues and/or any other metrics that indicate the effectiveness of campaigns. (example: Google Analytics, WebTrends, etc)

Tracking Service :

Login URL :

Username :

Password :

Does the client currently using an citations sites?*

Yes No Unsure

If yes please list below.
Google Places Username : Password : Bing Username : Password :	Yahoo Places Username : Password : Facebook Places Username : Password :	Twitter Username : Password : Misc. Username : Password :

Misc. Information*