Client Insights FormFields marked with an * are required. Today's Date* MM slash DD slash YYYY HiddenAccount ManagerUnknownAdela WardlowAnn SchmitterBrittney McConnohieDaniel PetragliaKevin JacobsonKimberly ShogrenLiz RzeznikOlivia HivelyPatrick LessorPeggy OlsonSunny SinghWeb TeamServices*Select all services in your package. Business Listing Optimization / Online Review Monitoring Google Posts Blog Social Media Management Website Marketing Campaign Landing Page Video Production Live Chat Pay Per Lead ProgramBusiness DetailsSales Rep*Tori MooneyWilliam AhoDeji WeseyRob Du HaimeValentina BoccaRyan OgurekJoe CoursolleSubmitted by: (Name)*Submitted by: (Email address)* I, the Submitted by name and email, verify all information is accurate and approved for submission to Business Listings.* YESContact Name*(Business Owner/Manager)Client Email*PLEASE NOTE:The below information must match exactly with what is on the business website.Official Business Name*Business Categories*Enter up to FIVE, separated by a comma, in order of importanceBusiness Address* Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Business Phone Number*Please select one of the following options for the client's business address submitted above:* Storefront Address Shared Office Space Address Residential AddressMobileFaxWebsite Address/URL**Website is required for listing optimization.Business Email**to Publish to Directories (Enter NONE if there is not one.)Short Business Description (for Directories)*Max 200 charactersLong Business Description (for Directories)*Enter a detailed description (Max 750 characters for Google) of the company. The description can be about your company's uniqueness and products or services. DO NOT enter any contact data like Email, phone, or website.Services Provided*Inform your customers about services provided at the location (please list the services you provide your customers)BrandsYour customers might be searching for specific manufacturers and retail brands. Let them know what brands this location has to offer.Payment options*Help your customers plan their visit. What payment options are accepted at the location? Please specify which credit cards are accepted. Select All VISA MasterCard Discover American Express Cash Check Apple Pay Other (Please specify below)Other Payment Option*Languages*Let your customers know in which languages they may be served at the location.List up to 20 keywords/phrases, SEPARATED BY COMMAS, that best describe your business*Choose up to twenty keywords that are relevant to your business - start with most important first. These may be brands or services, and can be composed of several words.Hours of Operation*Enter daily opening & closing times.Logo:Required. Upload a jpg, png, gif, psd or ai file. PREFERRED: transparent .png or original layered .eps or .psd file - NOT a pdf file. Drop files here or Select filesMax. file size: 64 MB.Business Listing Optimization / Review MonitoringThis information is what will be submitted for business listings. Complete, accurate data is critical. Pay close attention to NAP (name, address and phone) data for business listings should be consistent with clients website .Businesses with more than one location MUST submit each location separately for LBL/ORM. Spreadsheets will not be accepted.For Business Listings, DO NOT PUBLISH the following:* Check all that apply Business Address (for "Service Area Only" businesses, please note this will reduce the number of directories your business info can be published to.) Business Email (Email to publish to directories)Attach 6-12 images for business listings and Google updatesSquare Logo min - 270 x 270 pixels | Banner min - 1080 x 608 pixels | Other Images min - 500 x 280 pixels *for business listing photos, square images work best! Drop files here or Select filesAccepted file types: jpg, gif, png, tiff, bmp, Max. file size: 5 MB, Max. files: 10.Social Media Profile Links:Facebook URL Instagram URL Pinterest URL Twitter URL LinkedIn URL YouTube URL Vimeo URL Foursquare URL Google PostsGoogle Access* We have access and will grant ownership We are unsure if we have access/don't have GoogleThe Following Industries DO NOT Have Ability to Post on Goggle:Adult EntertainmentCampCannabis shopCasinoConference CenterGun ShopHotel (all hotel categories)Vacation RentalThe Following Industries Have LIMITED ABILITY to Post on Goggle:Drug StoreMedical ClinicPharmacyPlastic SurgeonSkin Care ClinicBlogBlog access Our Web Administrator will post our blogs. We signed up for a new website. (Blogs will be posted by Digital Services AM.)Please provide us with 3-4 blog topics to start the campaign:1.2.3.4.WebsiteSelect Platform* WordPress Quick Build Sites WordPress Custom Site DesignHOSTING: All websites are on our hosting server.Number of Pages*List the pages/tabs to be included in the navigation.Is Monthly Maintenance included in this package?* Yes NoColors you would like us to incorporate(To provide the specific Hex # of the colors you'd like us to incorporate, please visit the following website: https://htmlcolorcodes.com/color-picker/)Call to ActionTo be placed on the homepage of site. I.E. Call for an appointment today! Or Call for a free estimate today! Etc.”CONTACT FORM:* Yes NoEmail address(es) that forms are sent to (separate multiple addresses by a comma): NOTE: Yahoo email addresses DO NOT WORK.*List the fields you would like on your contact form: EXAMPLE: 1. name 2. email 3. Phone # 4. messageField 1:Field 4:Field 2:Field 5:Field 3:Field 6:*Captcha will be used to cut down on spam.Assets Required for Sites (via DropBox)Your Account Manager will set-up the Dropbox folder and invite sales rep and client to access the folder. Should you have an existing Dropbox folder or Google folder, please provide a link. NOTE: High-quality images and content MUST be provided before we start the build of the website.Upload Assets Drop files here or Select filesMax. file size: 64 MB.WordPress Custom Site DesignPlease take some time to browse the internet to gather samples of sites you like the look of, layout of, colors, certain features or functionality.Please list 3-5 examples of websites that you like and explain which elements (e.g. slideshow, font, image gallery, calendar, layout, etc.) you like and why you like them.Website Design Examples:1. (www.websiteaddress.com) 2. (www.webaddress2.com) 3. (www.similarindustry.com) NOTE reasoning below1.* 2. 3. 4. NOTES about Examples above:1. (www.websiteaddress.com) I would like to use this color scheme or I like these fonts/typestyles. 2. (www.webaddress2.com) I like the navigation on this site & would like mine to look like this 3. (www.similarindustry.com) I DO NOT like this website - it’s too clutteredDescribe the look/feel you want for your site.*E-commerce functionality:* Yes NoNOTES to Developer/Designer:WordPress Quick Build SitesInsert LINK to the ONE template you would like?****View TEMPLATES Additional Contact Form FieldsDOMAIN INFO:Do you currently own a domain?* YES NOClient is responsible for purchasing their domain. We recommend Namecheap or GoDaddy.If you have an existing domain please fill out this section.Existing Domain Name/URL(e.g. www.companyname.com)Registrar Login info to manage existing domainRegistrar Site/URL: (e.g. www.registrarprovider.com)Registrar UsernameRegistrar PasswordEMAILS:PLEASE NOTE: It is best to have emails hosted with your domain registrar or set-up through a third party such as Google Apps for Business or Office 365.Do you currently have emails associated with your domain name?*If yes, please list them: (e.g. info@acme.com,sales@acme.com, etc.) Yes No1.2.3.OTHER FEATURES:What other features, functionality would you like included on your website. List sample sites that have the features you like. EXAMPLE: Calendar, Photo Gallery, Menu, Submission FormsMarketing Campaign Landing PageCall to ActionTo be placed on the homepage of site. I.E. Call for an appointment today! Or Call for a free estimate today! Etc.”Colors you would like us to incorporate(To provide the specific Hex # of the colors you'd like us to incorporate, please visit the following website: https://htmlcolorcodes.com/color-picker/)Assets Required for Sites (via DropBox)Your Account Manager will set-up the Dropbox folder and invite sales rep and client to access the folder. Should you have an existing Dropbox folder or Google folder, please provide a link. NOTE: High-quality images and content MUST be provided before we start the build of the website.Upload Assets Drop files here or Select filesMax. file size: 64 MB.Fields for Contact Form:*Email address(es) that form is sent to (separate multiple addresses by a comma): NOTE: Yahoo email addresses DO NOT WORK.*List the fields you would like on your contact form: EXAMPLE: 1. name 2. email 3. Phone # 4. messageAdditional Notes/Information:VideoEmail to Send Proof:* Copy Points to include in/on Screen Text NOTE: No more than 18 words p/line and should be short and focus on an overview of the business or one or two key products/services.Line 1Line 2Line 3Call to Action Text (i.e. Call now for a special discount.)*Music Style*RockClassicalPopCountryAlternativeOther (please specify below)Other Music StyleIf you selected "Other" above, please specify what kind of music style you'd like for your videoSocial Media ManagementPlease note any preapproval of posts will incur an additional monthly fee.Social Channels*Please indicate the social channels we will be managing. Select All Facebook Google Instagram Twitter Pinterest LinkedInGeotargetWhat is your Geographic Service Target Area?Instagram LoginsPinterest LoginsTwitter LoginsIndustry ResourcesAre there any websites or online resources you follow that relates to your business? Sharing this will help our content team with researching your industry.What voice do you want for your social media?IE: fun, professional, serious, carefree, etcWhat are your goals for social media? Select All Increase followers Direct fans to the website Increase post reach Engage with your fansre: Social PostingPLEASE NOTE: If you would like on-going pre-approval of social posts, a recurring monthly fee will be added to your services.Additional InformationTell us anything else we should know about your social channels, i.e. if you have duplicate Facebook pages, lack access to one of the social channels you'd like us to manage, etc.SOCIAL ACCOUNTS -Please include URLs for your business account(s).Facebook:Instagram:Pinterest:Twitter:LinkedIn:Other:Live Chat Pay Per Lead ProgramLead Email(s)*Where your leads will be sent to. Cell Phone Number(OPTIONAL) For text message notifications of leads.Mobile carrierIf you'd like leads also texted to you, list your carrier ie. Verizon, AT&T, T-Mobile, etc.Google Analytics Code - UA-If you’d like to track chat leads via GACRM Integration (optional)List the CRM you'd like to integrate with. We will need the API key.Optional Add-On Features Call Connect (included) SMS Text-to-Chat (upcharge) Exit Pop Up (included) Google Integration (upcharge) Spanish Language Chat (upcharge)If you charge a Consultation Fee, what is the charge. Or enter FREE.Geographic Area of Coverage/Service Areafor example, Worldwide, Continental US. BEST to provide STATE(S), CITY(IES). Radius not allowed.Does their account need to be HIPAA compliant?* YES NOWould they like to have “Call Connect”? YES NOIf yes, what phone number?What days & hours are available?For Medical clients – Do you accept insurance? Is there a particular response you’d like us to deliver when asked about insurance?reCAPTCHACommentsThis field is for validation purposes and should be left unchanged.