1. Contact Information

Company Name:
Contact Name:
Address:
City:
State:
Zip Code:
Phone Number:
E-Mail Address:
Website Address:
We prefer to be contacted via: Phone E-mail Mail

 

2. Request Information

I am interested in the following products:

Website Development Payment Processing
Website Hosting Internet Access

 

3. Company Background

How long has your company been in business?

New 1-5 years
Less than 1 year Over 5 years

How many employees do you have?

Less than 5 21-50
5-20 Over 50

Please describe your products and services:

How do you currently sell your products and services?

Retail Distributors
Mail/Phone Order Other:
Direct Sales Force    

 

4. If developing a website, please complete the following:

In what time frame would you like to establish a website?

Within next 30 days This year
Within 90 days Unsure

What objectives would you like to accomplish with your website?

Selling products (E-commerce) Internal communications
Advertising, sales support Product support and service
Provide information Other:

What is your website size estimates?

1-5 pages 11-20 pages
6-10 pages Over 20 pages

Have you determined a budget for the project?

Website Development Payment Processing
If yes, please specify:

 

 

For more information about ECOM,
please contact info@ecomecs.com.

 

 
  Contact info@ecomecs.com
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