1. Full Name *
2. Email Address *
3. Business Name
4. Phone
5. City *
6. State * Alabama Alaska American Samoa Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Northern Marianas Islands Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Virgin Islands Washington West Virginia Wisconsin Wyoming
7. Preferred Method of Contact *
8. Phone Email
9. Do you have a domain name (www.yoursite.come)? *
10. Yes No
11. What is your domain name, or what do you want it to be? *
12. What is your budget? * $600-1000 $1000-1600 $1600-2500 $2500-4000 $4000 and up
13. When do you need to have your site done? *
14. Do you want a coming soon page? *
15. Yes No
16. Do you already have a logo? *
17. Yes No No, but I would love it if you would design one for me!
18. About how many pages of content will you have? *
19. Would you like a contact form? *
20. Yes No, I can just display my email address.
21. Would you like a blog? *
22. Yes No
23. Would you like to have a mailing list signup? *
24. Yes No
25. If you will have a mailing list, would you like us to help you create your newsletters? *
26. Yes No
27. Would you like a slide show or photo gallery on your site? *
28. Yes No
29. Would you like us to integrate Twitter, Facebook, or other social networking on your site? *
30. Yes No
31. Would you like for us to create custom ad banners for your site? *
32. Yes No
33. What print designs do you need? (Business cards, stationery, posters, etc) *
34. Do you need any custom illustrations? (If yes, we will contact you for more information) *
35. Yes No

E-Commerce Section (ignore if you don't need an e-commerce site)

1. Would you prefer that we input your products for you? *
2. Yes No
3. About how many products will you have? *
4. How many product categories? *
5. How many product sub-categories? *
6. Will you provide more than one image for each product? *
7. Yes No
8. If you have an Etsy shop, would you like a new banner to match your new website design? *
9. Yes No

1. How did you hear about 21 Ruby Lane? *
2. Please tell us a bit about you and your business: *
3. Any other questions or comments for us?
4. 

 

a design studio

designs by Rhiannon,
coding by Valerie
creating effective design
with function & style.

© 2009 21 Ruby Lane. All rights reserved.

• 602 466 8783
• info@21rubylane.com
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