| Title: |
Ms.
Mrs.
Mr. |
| First Name:* |
|
| Last Name:* |
|
| Phone:* |
|
| Fax: |
|
| Email Address:* |
|
| Company/Association: |
|
Have you already
registered/purchased a domain name?*
(A domain name is
www.yourcompany.com) |
Yes
No |
| If yes, what is the domain? |
|
Primary Service Area:
(adjusters, investigators,
attorneys, etc.) |
|
| I am interested
in: (Select all that
apply.) |
Claims Management System |
Document Manager |
|
A new Web site |
Updating my current Web site |
|
Logo development |
Banner Ad Design |
|
Search engine submissions |
Domain name selection/registration |
|
eMarketing/Promotional Services |
Content Management |
|
Personalized E-Mail |
Shopping Cart/E-Commerce |
| Other:
|
I'd like my Web site to
be: |
|
I am interested in
features
that would allow my site to do the following:
(Select all that apply.)
|
|
Provide details about our company history. |
|
Provide details about our lines of service, fee
schedules, etc. |
|
Provide details about our member/office locations,
including maps/directions. |
|
Provide member/employee details, including experience,
training, licensing, etc. |
|
Present a professional image, much like an attractive
marketing brochure. |
|
Promote specific products with detailed information
and images. |
|
Allow site visitors to contact us electronically
(via e-mail). |
|
Use online forms to obtain information (feedback,
marketing inquiries). |
|
Use online forms to accept registrations (training
classes, etc.). |
|
Use online forms to accept new claim assignments. |
|
Post jobs and accept resumés online. |
|
Post news/announcements about your organization. |
|
Maintain an online calendar of industry events. |
|
Provide a claims resources directory. |
|
Provide a Photo Gallery (officers, employees,
claims scenes, etc.). |
|
Provide an interactive experience, including discussion
forums/chat. |
|
Provide fresh content that encourages visitors
to return regularly. |
|
Generate revenue through advertising, affiliate
programs, etc. |
|
Provide claims industry news, with daily updates. |
|
Display custom service area, territory or other
map types. |
|
Sell products or allow users to pay for event
registrations or other items. |
| Other:
|
Questions and/or
Comments:
|
