WEBSITE INTAKE FORM

1
Contact Name* This field is required.
First Name
Last Name
2
Email* This field is required.
example@example.com
3
Business Phone Number* This field is required.
Please enter a valid phone number.
4
Business Address* This field is required.
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
5
Business Name* This field is required.
6
Hours of operation* This field is required.Example: Monday-Friday 9-5
7
DOMAIN NAMEIf you already own a domain name or website URL (i.e., www.yourwebsitename.com)
8
Do you have website hosting already?If not, just say no and we will get one sent to your for approval
YESNO
9
Do you have a Logo you wish to use? If yes, please upload a copy of your logo in .jpg and .png format to your Google Drive account, that we will send you. If you don't have a logo, please let us know, and we can make one for you for an extra charge.
YESNO
10
What products or services do you wish to list on the website?Just make a list of the main things you want to market.
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11
What geographic areas do you serve? Please list all towns/cities, counties, and zip codes you wish to list on your website.
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12
Do you have any customer testimonials you want to add/showcase on your new website? If so, please upload the text of each testimonial into the Google Drive we have created for you. Please also upload any relevant photos that may accompany each testimonial.
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13
Do you have any photos/images you wish to add to the website?Please upload the additional photos/images you wish to add to the same Google Drive account and, if needed, make the appropriate folders to group them properly.
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14
About Us Page ContentPlease upload to Google Drive the copy/content that you wish to see on the About Us page: - Company owners/managers' bios - Company history and mission - Company achievements or awards, etc.
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15
Social Media Links:Facebook Twitter Linkedin Google Yelp Bing Yahoo YouTube
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16
What 15 Keyword phrases do you wish to be found for on Google? We will research all of them, but we need your insight to begin this process.
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17
What makes you better than your competitors? Why should people choose you over them?
18
What is the average cost of any item/service you sell to your clients?
19
What is the Lifetime Customer Value of each client?How much money do you expect to make from each client for as long as they remain your client?
20
How long do clients usually stay with you? Days, Weeks, Months, Years, etc.?
21
What kind of Offer to you make for your Prospects? Marketing without an offer is just Branding. Please list any offers that you are thinking of.
22
Where do you feel most prospects will find you?Choose one
Desktop
Mobile Phone
23
ReviewsWhat kind of Reviews do you have that we can use in our campaigns? If there are any negatives, please give us some details as to why.
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24
PLEASE describe your perfect client Age, Sex, Income Level, Education, Interests, Children, etc. Are there any other demographics we need to know regarding your perfect client?
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25
Please add any additional Comments
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