Local Business Intake

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:

Business / Office Hours:

Payment Methods Accepted [Highlight all that apply]:

Cash
Cheque
Debit Card
Visa
Discover
Master Card
American Express
PayPal
Invoice

In Business Since:

Primary Keyword / Tags:

Business Description - Short (300 Characters Max):

Business Description - Long:

Business Logo: Upload Here

Accepted file types: jpg, jpeg, png, gif.

Media/Images/Videos

We will send a link for media to be uploaded via Dropbox or Google Drive.

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, Instagram, Twitter, Pinterest, Blog):

Owner Information

Name

First Last

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)

Accepted file types: jpg, jpeg, png, gif.

Wordpress Login info: username/password

Server/Cpanel 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)

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Local Business Intake