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