| ID | |
| Name (First, Last) | |
| Address | |
| City, State, Zip | , |
| Phone | |
| Male/Female | |
| Your Age | |
| Do you have Children? | |
| Pets | What type? |
| How would you best describe your overall character? | |
| Which color palette do you find most pleasing? | |
| What types of fashions do you most enjoy wearing | |
| Which of the following best describes what is most important to you when choosing a piece of furniture? | |
| How would you describe your personality? | |
| What type of decorative accessories would you prefer to have on display in your home? | |
| What is your favorite season? | |
| Which type do you see yourself as? | |
| Tell us a bit about your self; likes, dislikes are you the serious type, whimsical, etc | |
| What type of hobbies do you enjoy? | |
| What will your web site be comprised of? (Product, Service, Personal) | |
| Are you supplying graphics? | |
| How do you envision your graphics displayed? | |
| Do you want frames on any graphics | |
| Do you want animation? | |
| What style/shape of buttons do you like? | |
| How many buttons will you need? | |
| Do you like buttons across the top | |
| Do you like buttons down the right side? | |
| Do you like a combination across top and down right side? | |
| Additional Comments |