Business Information Intake Form
Full Name
First Name
Last Name
Mobile Number
Your Email Address
example@example.com
Business Name
Business Main Telephone Number
What industry are you in?
Animal Products/Services
Auto Products/Services
Beauty Products/Services
Business Products/Services
Catering/DJ/Events
Child Care Services
Cleaning Products/Services
Consulting
Dentist
Electician
Florist
Government/Non-Profit
Health & Wellness Products/Services
Healthcare Provider
Home Improvement & Maintenance
HVAC
Insurance
Lawn Care
Legal Services
Locks & Locksmiths
Moving & Storage
Other Home Services
Photography
Plumbing
Real Estate
Roofing
Special Event Venue/Restaurant
Veterinarian
Wedding Products/Services
Other
What are your specialties within your industry?
How far is your business reach?
0-10 Mile Radius
10-35 Mile Radius
35-50 Mle Radius
Over a 50 Mile Radius
How many employees do you have?
0-3
4-8
More than 8
What stage are you in your business?
Start Up
Slow Growth
Re Structure
Quick Growth
Retiring and selling
Closing
Considering Starting
What is your unique market niche or why do people typically choose you over their other options?
Does your business have a personality?
Adventurous
Bold
Conservative
Dependable
Edgy
Energetic
Friendly
Flexible
Healthy
Imaginative
Inventive
Jolly
Kind
Luxurious
Pratical
Sexy
Spiritual
Stoic
Tough
Warm
Wholesome
Other
Does your business have a color scheme?
Have you ever surveyed or looked at feedback on how clients/potential clients view interacting with your business online?
Yes
No
Who supports your website?
I don't have one
Self Serve
Hired Designer/Developer
Hired Maintenance
I provided the content
The content was created for me
Other
Website Software
What features do you provide to visitors?
Click To Call
Chat
Self Serve
Customer Account
Security
ADA Tools
HIPAA Compliance
Videos
Shopping Cart
Scheduling
Estimates
Catalog
Email/Newsletter Sign Up
Coupons
Self Learning
Other
Interaction Tools/Software
How do people find your website?
Search Bar
Social Media
Internet Advertising
Voice Search
Videos
Online Reviews
Blogging
Vehicle Wrap
Billboards
Mailers
Magazines
Radio Advertising
TV Ads
Other
Other
Advertising Programs
What are you wanting people to do when they find your business?
Book Services
Buy Something
Get an estimate
Find Information/Self Help
Other
How do you want people to connect with you?
Text
Email
Chat
Fill Out A Form
Book Online
Call
Other
How quickly do you respond?
Interaction Software
How do you keep your day/notes/requests/work organized?
Pen/Paper
Free Calendar
Software Calendar
Other
Do customers ever ask for information about goods/services/choices/pricing?
Yes
No
How do you provide the information?
How do you keep your client up to date about confirmations, arrival time?
Direct
Phone
Software
Other
Are you, customers and employees always on the same page about work/order/project status?
Yes
No
Management Software
How are you invoicing?
What forms of payment do you accept?
Cash
Check
Credit Cards
ACH Payments
Apple Pay/Google Pay
Bit Coin
Subscription Payments
Other
Do people ask for other options to pay you?
Transaction Software
How do you say Thank you after the transaction?
Receipt
Email
Text
Personally
Other
Do you ask for feedback when the work is finished?
Yes
No
Do you ask for and make it easy for someone to leave an online review?
Yes
No
Do you have a referral program?
Yes
No
How often do your reach out during the year to stay connected?
And what do you say when you connect?
Happy Birthday
Happy Holidays
Service Reminders
Specials
Community Information
Industry Information
About your business
Other
Engagement Software
How successful do you feel in getting a desired outcome from your online business efforts?
I don't know
It's working but I need it to do more
It's extremely successful
Other
Are you interested in learning how other businesses are simplifying customer interaction from engaging with the website, throughout the work and after the work while reducing overall costs and getting better outcomes?
Yes
No
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