Web Design Form - Please complete

Web Design Form - Please complete

Information form for the website you would like to get it designed
Name & Surname*

NameSurname
Phone Number

Area CodePhone Number
Mobile
E-mail*
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Area of work - industry
Do you have a domain name ?

YesNo
Is your web site hosted now ?

YesNo
Your expectations from the site :

Information source for the existing clientsTo capture more client by re-vamping the existing site or developing a new one for the intended purposeWishing to inform the public and and keep my / our campaigns and new additions up to dateReceive purchase orders via website and respond clients fasterOnline shopping site - credit & debit card online payment system
Exceptions from the proposed website in your own words
Could you name existing websites that you like you see in the internet that you like most. That you wish your proposed website to look and perform similar to those you like most. Please provide a link or the name of the site! Could you make a list of features from those websites that you like in those websites most ?
Features you would like in your website

More than one language optionBrowsing acknowledgement - cookiesSearch engine registering - rankingGoogle ad words - pay per clickSearch engine optimization
Budget for the Website*

£500 - £1500£1500 - £2500£2500 - £4000£4000 Above
Should be Empty: