Needs Assessment Form

Congratulations !

You have come to the right agency for supporting all your internet website needs.

Time is valuable. To save us both time and provide us a starting point for a technical assessment of your Internet or  Website needs please review and complete our Needs Assessment form below.

This information will assist us to better understand you and how we can BEST assist you in achieving your future Internet Success !

Thank-you for selecting  EMPARC to assist.


 Company Name 
Your Full Name 


Your Email Address 
Your Telephone Number

Please tell us what items or materials you can provide us at our initial meeting for inclusion in our assessments.
  Brochure ( Print or Electronic Copies )
  Artwork and/or Photographs
  Copy/ Subject Matter Written Content
  Logo ( Original Artwork)

Select all buttoned items that you anticipate your website will require or need.
Need Design of New Website
Need Website Domain Name
Need Website Hosting (Web Server)
Need  Content Assistance ( Written Copy)
Need Website for selling  products
Need Website for selling services
Need a Website for informational purposes only
Need Customer Feedback and/or Support Online
Need Payment Processing Online ( E-Commerce)
Need Online Forms ( Obtains Customer Information)
Need Search Engines Optimization ( Google, Yahoo, Bing, etc. )
Need Customized Web-Marketing Campaign
Need Email marketing campaigns
Need Online Forums, Blogs, Bulletin boards, etc.
Need Ongoing Monthly Website Support and Maintenance

How many Sections (Webpages) do you estimate you will start your site with ? Please select the buttoned items you may need or anticipate ?
Less < 5 Webpages/Sections  
 5 to 10 Webpages/Sections  
11 to 15 Webpages/Sections  
16 to 50 Webpages/Sections  
50 to 100 Webpages/Sections  
101 or more Webpages/Sections  

Please describe for us your future website expectations. For example: What do you envision your website will do for you or your company in the future ? Are there any special features or styles you want us to consider in your design?


Please list at least 3 competitor websites as an example that you admire or like the look and feel and/or navigational qualities. http:/www. not needed.


Budgetary Constraints
How much have you budgeted
for this project ?

( Select One )
$800 to $1,000
$1,000 to $2,500
$2,500 to $5,000
Over $ 5,000

Additional input or thoughts to the agenda for our meeting: