This form is here as a resource for our account managers, web designers, and content specialists to gather basic information from our clients to use in their awesome new website. Please fill out the form below in it's entirety. (The more information we have, the better your website will be.)


High Five Media Account Manager
High Five Media Account Manager
Please provide a brief description of the company and what services they provide.
This phone number will be used on the contact page.
Please provide the business address in it's entirety.
Date of Form Submission *
Date of Form Submission
If the client currently has a domain, please provide the domain here. (Also include the Username/Password to access the domain)
Please provide the current host of the domain. (GoDaddy, Bluehost, etc.)
Please provide the desired domain if they do not already have one.
Do you currently have business emails that are hosted by your current web developer? *
What is the primary goal of your website content?
Who is your demographic?
Content Status *
Pages *
Check the pages that apply to the needs of the client.
If there are additional pages needed that were not previously listed, put them in the text field below.
Please provide social media accounts that will be used on the site. (Usernames & Passwords are required for linking accounts to the site.)
Expected Date of Completion *
Expected Date of Completion
Please provide the date in which the client expects the site to be up and functional.
Would you like icons for the highlighted profit centers/pages?
Are there any specific features that are important in the design of the site?
The website should encourage visitors to: *
Please provide a color scheme to use as a starting point.
If there is a website that the client likes the look of, provide it here.
Please provide keyterms you would like us to optimize the site for.
If there are special requests or a functionality not previously listed provide it... HERE \/
Other High Five Media Products Sold *
Check List (Internal Use Only)