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Web Page Design - Needs Assessment

EZNET provides full web solutions. We offer full database, commerce, and customized web based solutions.

Because each job is unique, please fill out this form and a sales representative will contact you. And he will be able to schedule a face to face meeting to see how EZNET can meet your web based needs.

If you are having trouble with this form, you can print out and fax this offline form

Contact Information

City, State, Zip
Phone Number:
Fax Number:

What is the best way to contact you?
Phone E-mail

Web Site Information

What is the nature of your business?

What is your current Web site address?

Do you have a host for your site, and if so , whom?

Why do you want a Web site and what would you like it to do for you?

Do you have a budget for this site/project? yes no

Do you want to sell something on this site, and if so, what?

Do you have a merchant account for this site? yes no

How do you plan to advertise, market, leverage this site?

Is the site planned out and flowcharted? yes no

Do you have a logo, yes no
and if so, do you have an electronic version? yes no

What is your time-frame/deadline for this project?

Please list any additional information that you feel may be useful in assessing your needs, like URLs that you like or of your competition, concerns you have about this project, etc.

St. Marys Hospital

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