This questionaire is for those who are interested in talking with Opper Internet Concepts (OIC) about creation of a web site. Please fill out as much of the information as you are able. Contact information and email information is required to process. Thank you!

YOUR INFORMATION
Contact Name:
Company (if any):
Address:
City, State, Zip:
Country:	Select USA Canada Afghanistan Algeria Armenia Angola Antigua Argentina Aruba Australia Austria Bahamas Belgium Belize Benin Bolivia Bonaire Botswana Brazil Bulgaria Cameroun Carribbean Central Africa Chad Chile China Colombia Commonwealth Of Dominica Congo Costa Rica Croatia Cyprus Czech Republic Denmark Dominican Republic Ecuador Egypt El Salvador England Estonia Ethiopia Finland France Gabon Germany Greece Grenada Guam Guatemala Guyana Holland Honduras Hong Kong Hungary Iceland India Indonesia Iran Ireland Israel Italy Ivory Coast Jamaica Japan Jordon Kenya Korea Kuwait Latvia Lebenon Liberia Lithuania Luxembourg Madagascar Malaysia Mali Malawi Mauritania Martinique Mexico Namibia Nepal Netherlands New Zealand Nicaragua Niger Nigeria Norway Oman Pakistan Panama Paraguay Peru Philippines Poland Portugal Puerto Rico Romania Russia Samoa Scotland Senegal Serbia Sierra Leone Singapore Somalia South Africa Spain St. Maarten St. Thomas Suadi Arabia Sudan Surinam Swaziland Sweden Switzerland Syria Taiwan Thailand Tanzania Togo Tortola Turkey Turks and Caicos Uganda United Kingdom Uraguay Venezuela Vietnam Volta Yemen Zaire Zambia Zimbabwe Unlisted
Contact's Email Address:
Contact's Phone:

ABOUT THE SITE

The site would be a:

Commercial web site Nonprofit web site Information web site Personal Home Page

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Describe your business or organization (Commercial & Nonprofit Web Sites Only):

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What are the purposes for the web site? (no more than 600 characters)

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Do you already have your own artwork, and if so is it a digital format?

Yes No

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Is the text you wish to be used proof read and ready to be copied to your pages?

Yes No

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Do you see a need for interactive forms, such as a guestbook, on your web site?

Yes No

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Please type in the addresses (URL's) of three (3) web sites whose features you like.

http:// http:// http://

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What special features, if any, would like included in your site? (like animation, video, e-commerce, audio)

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Please select a range that reflects your budget for developing a web site :

$1,000 - $2,999     $2,000 - $3,999     $3,000 - $4,999     $5,000 - $9,999

$10,000 - $19,999 $20,000 - $49,999 $50,000 - $99,999 $100,000 or more

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ANY OTHER COMMENTS