Neurolinx

Neurolinx Design Request Form

Please fill out as much information as you can regarding your design project.
We appreciate you taking the time to fill out this form. We are excited to work with you and look forward to the opportunity.
We will get back to you within 24 hours with our response. Thank you for your interest!

I. The Basics

Company Name
Full Name:
Email:
Phone:
Address
City
State
Zip code

II. Project Goals

What are your short term and long term goals for this design project?
Who is your Target Audience?

Desired completion date?
Is the launch date negotiable?	Yes No
Do you have your own Logo and graphics?	Yes No

III. Design

What industry or field is your business in?
Please give a brief summary of what your business does.
What is your company Mission Statement and/or Tag lines?
Please describe the look and feel you desire for your graphics and functionality, if applicable. If there are any examples of sites, pictures, or advertisements, websites please list them..
Are there are any colors that you do not want used?
Do you only want to use company colors, if so what are they?

What service(s) are you interested in? Examples include:
Web design, Logo Branding, ,Illustrations, Printwork, and more(Business Cards, Brochures, Posters, Flyers, etc.)

See our entire list of services here

If you are interested in services other than web design, please list examples or describe the look you are looking for.

IV. Website ( if applicable)

a. Site Basics

Do you currently have a website

Yes No

Who are your competitors?
Provide a list with their web site addresses.

What do you want users to be able to do on the site?
What is the MOST important area of the site? Please give a brief statement on what should be focused on for this area.

b. Website Look and Feel

What kind of look do you want your site to have? If you have example websites please list them.
Do you want to only use company colors on the site?	Yes No
Are there are any colors that you don’t want used on the site?

c. Website Technical Info

What is your Domain Name?
Who is your current web hosting provider if you have one?

Are there staff members in your business working on the website project? Please list of staff members and/or freelance resources and indicate the responsibilities of each person.

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