New Client Intake -

WELCOME!

Please Fill out this form in it's entirety(to the best of your ability) so we can have everything we need to help you on your journey towards success. The decision to invest in SEO services has changed the lives of many before you. This is not All-State, but I want to assure you that, "You are in Good Hands." Please don't hesitate to ask any questions you may have. We will do our best to make sure you are informed and updated frequently.

LBI (Local Business Information)

Please enter as much information below as you can. We will use this information to create or improve your online listings.

Business Information
Company Name:*
Address:*
Street Address City State / Province / Region ZIP / Postal Code Country
Address 2: (IF)
Street Address City State / Province / Region ZIP / Postal Code Country
Phone:*
Fax: (IF)
Toll Free Number: (IF)
Website:*
Profile Email / Web Mail / Business Email: (IF)
Business Type / Category:*
Products / Services:*
Products / Services:*
Business / Office Hours:

: HH

MM
Payment Methods Accept [Highlight all that apply]:*
- Cash
- Cheque
- Debit Card
- Visa
- Master Card
- American Express
- Discover
- Diners Club
- PayPal
- Invoice
- Financing
- Travelers Cheques
- Euro Card
In Business Since:*
Primary Keyword / Tags:*
Business Description - Short (200 Characters Max):*
Business Description - Long:
Business Logo: Upload Here
Photos (Min 10 Photos): Upload Here
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Photo 1
Photo 2
Photo 3
Photo 4
Photo 5
Photo 6
Photo 7
Photo 8
Photo 9
Photo 10
Video URL (Try to give 5 Videos): (IF) url
Additional Information
Tag Line / Business Slogan: (IF)
Specialties (exclusive products, areas of expertise): (IF)
Cities Served / Counties Served / Areas Served: (IF)
Language Spoken: (IF)
Wi-Fi: (IF)
Parking Available (Yes/No): (IF)
- Yes
- No
Reviews: (IF)
Testimonials: (IF)
Coupons & Specials [Get more business by adding an offer or discount. You can update or delete your coupon at any time]: (IF)
Offers [like this - 20% off all haircuts, Expires: Oct 15, 2013]: (IF)
Brand Names Carried: (IF)
Affiliations (BBB Member, Sites / Trade License#, chamber of commerce etc...): (IF)
Social Media Page URLs (Face Book, Twitter, Blog): (IF)
Owner Information
Name*
Position / Job Title:*
Owner / Contact Person Gender:*
- Male
- Female
Owner / Contact Person Date of Birth: (IF)*
Owner / Contact Person Bio: (IF)
Owner / Contact Person Location: (IF)
Street Address City State / Province / Region ZIP / Postal Code Country
Owner / Contact Person Photo: (IF)
Wordpress Login info: username/password*
Google Business login and url:*
Domain email account for US: please setup an email acct @your domain.com for us to use.
Note: Previous Business Name, Address & Phone for editing business: (If business was submitted many times by you or other SEO worker)

LBI (Local Business Information)

Business Information

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Additional Information

Owner Information