Language
English (US)
Spanish (Latin America)
Website Order Form
Business Name:
*
Primary Contact / Business Owner
*
First Name
Last Name
Business Phone Number:
*
Inbound calls forward to
Cell Phone:
*
Forward lead notifications to
Primary Email:
*
Used for invoices and/or login
Secondary Email: (optional)
Used for software login
Current Website URL:
Upload Your Logo:
Browse Files
Drag and drop files here
Choose a file
Cancel
of
If you have social profiles for your business paste the URLs below:
If not, skip this section
Google My Business/ Google Maps URL:
Youtube Channel URL:
Facebook Business Page URL:
Instagram Business Page URL:
Personalize Your New Website With Your Favorite Images:
Original copies or new photos work best, screenshots will degrade
Select 'Yes' below if you would like us to use images from your current website and social media profiles. If yes, you may skip the image upload section.
Yes
Upload 3 Background Style Images That You Like:
Browse Files
Drag and drop files here
Choose a file
These can be images you want us to use or examples we can get creative with.
Cancel
of
Upload 3-5 Images of Your Office, Staff, or Photos That Represent Your Business:
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Upload 3-5 Product, Installation, or Before and After Images:
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Business Details, Products and Services:
Please list your industry, products and/or services offered, and the service areas of your business. This helps your website be found for the most relevant terms.
Primary Business Category:
*
If possible, match your Google My Business category
Primary Product or Service:
*
The focus of the business, what makes the most $$
List Additional Services: 1 per line
List Additional Products: 1 per line
List the cities, states, or countries we should target for website traffic. 1 per line
*
This is for location based keywords
List 5 to 10 Keywords Most Relevant to Your Business: 1 per line
*
Do customers visit your business?
*
Yes, customers come to us
No, we always go to the customer
Both
Online Business
Customer focus is:
*
Commercial
Residential
Both
Website Orders
Desired Password for Software Login:
This will be your password to access the website and contact leads; If you do not enter one we will generate at random.
Show Me How To Change This Password:
Yes
No
I have provided accurate information to the best of my knowledge, I am signing this agreement, "Winfluential - Website Service Agreement" on behalf of:
*
Business Name
Your Name:
*
First Name
Last Name
Signature:
*
Submit
Should be Empty: