www.MomentumNetwork.com Business Development Consultants Global Channel Marketing & Support For Small to Medium-sized Businesses

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Our team of talented interactive designers, certified programmers, and seasoned project managers will ensure that your development projects are on time, on budget, and within specifications. For a free consultation please fill out the form below.

* indicates required field First Name Last Name Company Name Years in business Select >> Startup 1-3 3-6 6-9 10+ Industry Select Agriculture/Chemical Consumer Goods Education Engineering/Construction Finance Government Healthcare Leisure and Hospitality Manufacturing Media Mining Oil and Gas Retail Pharmaceuticals Services Technology/Science Telecommunications Distribution and Transportation Utility Other Other Contact Email xxxx@xxxx.com Contact Phone () - Ext Fax () - Cell Phone () - 1. Are you currently working with a Momentum Coach? yes   no Coach's First Name Coach's Last Name Coach's ID Number   2. Do you have an existing website? yes no Current web address ex.http://www.mysite.com Who created it? Select >> advertising agency agency self made in house development consulting firm Web address of agency that created your site (if applicable).   3. What services are you interested in? Select >> Creating a new Website Redesign/Editing my existing Website Adding functionality to my existing Website Search engine optimization Email Marketing Pay per click campaign Interactive cdrom Other   4. Please select the type of website you currently have or would like to have Select >> E-Commerce Corporate Informational Hybrid What is the main goal of your website? Select >> Establish an e-presence Provide information Sell products online Sell products via auction base Provide customer service Offer a virtual community Intranet/Extranet Other Other   5.Project Priorities Please indicate below your development priorities 5.1 Budget (estimated investment) Important --------------------- less important 1 2 3 4 5 Total estimated budget for this project. Select >> $5,000-10,000 $10,000-30,000 $30,000-60,000 $60,000-100,000+ unknown (USD) 5.2 Time (due dates, urgency, product launch) Important --------------------- less important 1 2 3 4 5 Estimated start date for this project? MM/DD/YYYY What is your projected deadline for this project? MM/DD/YYYY 5.3 Functionality (Database, Multimedia, Interactivity, Customer Relations Management) Important --------------------- less important 1 2 3 4 5 Please indicate your interest level in the following features: (1 = very important; 5 = not important at all) 1 2 3 4 5   Logo/Identity Creation/Facelift 1 2 3 4 5   Flash Animation 1 2 3 4 5   Database 1 2 3 4 5   Forms 1 2 3 4 5   Search Engine Submission 1 2 3 4 5   Shopping Cart 1 2 3 4 5   Content Management System 1 2 3 4 5   Website Hosting 1 2 3 4 5   Photography 1 2 3 4 5   File Upload 1 2 3 4 5   Calculators 1 2 3 4 5   Advanced Animation 1 2 3 4 5   Video/Audio 1 2 3 4 5   Secure Transactions 1 2 3 4 5   Calendar 1 2 3 4 5   System Reports Other Features How frequently will you need your site updated? Select >> Daily Weekly Monthly Very Rarely Who will update your website? Select >> In-house, your company Momentum Network An outside design firm or provider Not sure Approximately how many web pages do you estimate need to be created? Select >> 1-19 20-39 40-59 60-99 100+ 6. How did you hear about Momentum Network? Select >> Internet Attended Seminar Local Momentum Coach Radio Ad TV Ad Fax Email Newsletter Other   7.Please give us the web address of other sites you like (if any). Give a brief explanation why you like them   8. Any additional information, questions or requests you would like to add? For your free quote please click     Thank you! A Momentum-Project Manager will contact you within 2 business days to address your web development needs.

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