Name:
Phone Number:
Email Address:
What kind of business do you have?
Are you interested in selling products online?	Yes No
If Yes, How many products do you want to sell?	None Less than 5 5 to 20 20 to 50 50 or more
What's the best way to communicate?	Phone Email Both In Person
What is your most pressing need for a website?	To have an online presence Increase my customer base Keep customers updated Sell products Other? (Please Explain)