Client Intake Form

    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*

    City*

    State*

    Zip/Postal Code*

    Country*

    Address 2(IF)

    City

    State

    Zip/Postal Code

    Country

    Phone*

    Your Website*

    Profile/Email/Webmail/Business Email*

    BusinessType/Category*

    Products/Services*

    Products/Services

    Products/Services

    Business/Office Hours

    Payment Methods (check all that apply)

    CashChequeDebitVisaMaster CardAmerican ExpressDiscoverDiners ClubPayPalInvoiceFinancingTravelers ChequesEuro Card

    In Business Since

    Primary Keyword/Tags

    Business Description - Short

    Business Description - Long

    Business Logo And Images: Choose Image










    Video URL (try to give 5 videos)

    Tag Line/Business Slogan

    Specialties / Exclusive Products / Areas of expertise

    Cities Served / Counties Served / Areas Served

    Language Spoken

    Wifi (IF)

    Parking Available

    YesNo

    Reviews

    Testimonials

    Coupons Specials: Get more business by adding an offer or discount You can update or delete your coupon at anytime: (IF)

    Offers like this - 20% off all hair cuts Expires: Oct 15, 2018:(IF)

    Brands Carried

    Affiliations BBB Member Sites Trade License, chamber of commerce, etc:(IF)

    Social Media Page URLs: FaceBook, Twitter, Blog:IF

    OWNER INFORMATION

    Name*

    Position/Title

    Owner/Contact Person/Gender

    MaleFemale

    Owner Contact Person Date of Birth

    Owner/Contact Person Bio

    Owner/Contact Person Location

    Address

    City

    State

    Zip/Postal Code

    Country

    Owners/Contact Persons Photo

    Wordpress Login info:usernamepassword*

    Server Cpanel Login info: user name/password

    Google Business Profile login and url

    Domain email account for us: please set up an email account @yourdomain 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)

    Previous Business Name & Phone Number