New Client Intake Form We’re standing by to help shine a light on your business. "*" indicates required fields Business InformationWe will use the following information to craft your marketing campaign. It is IMPORTANT to answer every question as accurately as possible. Company Name:* Exactly how your want your business listed. Address:* Street Address City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Location of business. Exactly how you want your business listed. Business Email* What email address do you want customers/clients to message you at?Website Phone:*Business PhoneToll Free Number: (IF)Products / Services*Please list the products or services that you offer. One item per line.Business Description - Short (200 Characters Max):*If you do not have a description, answer this question: If someone asks you what you do and who you do it for, what do you tell them?Specialties (exclusive products, areas of expertise): (IF) Cities Served / Counties Served / Areas Served: (IF)Language Spoken: (IF) Affiliations (BBB Member, Sites / Trade License#, chamber of commerce etc...): (IF) Social MediaIn this section, we will ask you for your social media URLs and logins. If you do not have them set up put N/A and we will create them for you. If you have already given us this information, please put "Already given."Facebook Business Page URL: Put n/a if you don't have a business page and we will create one for you.Business Twitter URL If you do not have a Twitter for your business, please put N/ABusiness Twitter Password If you do not have a Twitter for your business, please put N/ABusiness Instagram URL: If you do not have an Instagram for your business, please put N/A. If you have already given us this information, please put "Already given."Business Instagram Password If you do not have an Instagram for your business, please put N/A. If you have already given us this information, please put "Already given."LinkedIn Business Page URL: Please add Cheryl VanOrnum as an Admin of your LinkedIn business page. Youtube URL: If you have business videos already on Youtube, please list the URL of your channel. If you do not have one already, please put N/A.Youtube Login: Username/Password. If you have already given us this information, please put "Already given."Miscellaneous:Please list any other social media/review accounts or industry-specific profiles that you have along with your username and password. Example: YELP- https://yelp.com/biz/company-name (this is just an example) Other examples could include: Houzz, Pinterest, Psychology TodayOwner InformationName* Position / Job Title:* Owner / Contact Person Short Bio: (IF)Owner / Contact Person Location: (IF) Street Address City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Login InformationYour logins will remain private and will not be shared. We use this information to log in and optimize and also to track progress. If you have already given us this information, please put "Already given."Access to Google Products (If):If you already have a Google Analytics and/or Google Search Console account, please add [email protected] as a "manager". If you have one of these accounts but not all of them, please add [email protected] as a "manager" to the ones you do have and tell us the ones you do not have. Wordpress/Website Login info: username/passwordGoogle My Business login and url (If):Previously known as Google Maps. You are able to add users to your Google My Business (GMB) owner dashboard. Please add [email protected] as an owner. If you have not set up GMB, we will do this for you. Godaddy or Domain Registrar LoginIf we are creating or managing your website, please submit your username and password for your domain registrar (where you purchased the domain). Brand Info (Last section!)Is there a creative or interesting story behind why you started your business?What is your brand's mission & top values of your brand?What is your brand's "personality" in five descriptive words?When you picture your ideal customer, who does that look like?What type of lifestyle does this dream customer live? How old are they? Get as detailed as you would like.Upload Attachments Drop files here or Select files Accepted file types: jpg, gif, png, pdf, Max. file size: 10 MB, Max. files: 10. Image/ad inspiration: If there are specific marketing campaigns, social media channels, websites, etc. from other brands that you would like to take inspiration from, attach a few screenshots below or list the URLs right here.Logo & Fonts Drop files here or Select files Accepted file types: jpg, gif, png, pdf, ttf, Max. file size: 10 MB, Max. files: 5. Please upload your logo and if you use any custom fonts, please upload them here. Tell Us What Colors Your Brand Uses.Even better if you have the hex code!
