Get Us Listed PPC Client Intake Form

Contact
Contact information within your company to discuss PPC and send reporting
Name
Last Name
Email
example@example.com
Phone Number
Phone Number
Project Information
Business Address
Street Address
Address

Street Address Line 2

Street Address Line 2

State / Province
City
Website
Business Phone Number
Business Phone Number
General Business Email
example@example.com
Enter the hours you would like your ads to run
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Services You Would Like To Run PPC Ads For
Keywords
What are some examples of keywords you want to be found for?
Location Targeting
IE: State, Zips, Cities, Etc Please be as specific as possible.
Promotions/Offers/Specials
Do you have any specials or promotions that could be used to promote your business?
Distinguishing Characteristics
What makes your business stand out? Ex: Family owned and operated for 20 years
Calls To Action
Ex: Schedule Your Free Consultation, Call to Schedule an Appointment
Emails You'd Like To Receive Leads
Additional Information / Notes
Please provide any other information, notes etc.
Website Information
Logins / FTP
Please provide us with what we need to access the admin of your website.
Should be Empty:

Contact