Jake Buckingham Productions

Jake Buckingham Productions

CLIENT VIDEO PRODUCTION REQUEST FORM
This form helps us understand your vision, goals, and audience so we can create a video that’s effective, intentional, and aligned with your brand. Whether you're looking to highlight a product, share your story, or boost awareness — we’re here to help bring your ideas to life.

Please take a few minutes to complete this form with as much detail as possible. Once we receive the completed form, we will review and schedule a discovery call, Zoom or in-person meeting to discuss the details of the project and the next steps.

Let’s get started!
Name*

First NameLast Name
Company/Organization Name:*
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Preferred Contact Method:*

E-mailPhoneText Message (data rates may apply)
Company/Organization Website:
Facebook Page:
X (formerly Twitter):
Linkedin Profile:
Instagram Page:
Project Overview
Project Title or Name: *
What type of video(s) are you interested in creating? (Select all that apply)*

Brand VideoProduct DemoCommercial (TV/web)Social Media VideoFacebook/Instagram ReelsYouTube ShortsPromotional VideoMarketing Campaign VideoShort Film/DocumentaryEvent Recap VideoCustomer Testimonial/InterviewOther
Describe your vision for this video project. What do you want this video to communicate?*
What is the goal of this video? (Select all that apply)*

Highlight product features or benefitsPromote a serviceTell your brand storyIncrease brand awarenessDrive engagement or conversionsEducate your audience or customersRaise awareness for a causeOther
Who is your target audience? (Select all that apply)*

General PublicExisting CustomersPotential Customers / New LeadsInvestors / StakeholdersBusiness Clients / B2BEmployees / Internal TeamsEvent AttendeesCommunity MembersYouth & StudentsOther
Location Focus (Select all that apply)*

Local (e.g. Omaha, Council Bluffs, Lincoln)RegionalNationalInternationalOnline/Global Community
Where will this video be used? (Select all that apply)*

Company/Organization WebsiteYouTubeInstagramLinkedinE-mail MarketingIn-store DisplayOther
Project Details & Logistics

PRODUCTION PROCESS
Desired video length?*

30 seconds or less30-60 seconds1-3 minutes3-5 minutesOther
Do you have a script or storyboard?*

YesNot yet, I'd like help creating oneI have an outline or rough ideaNo
Preferred Style or Examples

Paste links from YouTube, Vimeo, Instagram, etc.,
Link #1
Link #2
Link #3
Additional notes on the style/feel you want:
Do you have existing branding assets? (Select all that apply)*

LogoBrand ColorsFontsExisting Video FootageProduct or Business PhotosOther
What is your deadline or target delivery date:*
What is your estimated budget range:*

Under $1,000$1,000–$3,000$3,000–$5,000$5,000–$10,000$10,000+Not sure yet
Additional Notes or Questions?
Should be Empty:

Jake Buckingham Productions

Project Overview

Project Details & Logistics

Preferred Style or Examples