Managed Web Presence/SEO Service Setup Form Step 1 of 4 25% Agency Information Please fill out this form as completely as possible! All fields marked with a red star are REQUIRED FIELDS. Make sure to read through this entire form and to give us complete, accurate information about your client and their business. Your First Name*Your Last Name*Email*Primary Contact Phone Number* Your Client's Company InformationCompany Name*Name of your client's company for this campaignDate Company was Founded* Date Format: MM slash DD slash YYYY Business Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Main Company Phone*Business Email Website Public Relations/Press Contact First Name Last Name Google MyBusiness Listing LinkBusiness Slogan or TaglineBusiness Industry/CategoriesPlease tell us what business categories your company would fit into. What industry or industries best classify your business (ie. cosmetic dentistry, auto repair, chiropractor, manufacturer, etc)List Hours of Operation*For example M-F 9 am to 5 pm and Sat. 10-3 pmPayment Methods Accepted - Check All That Apply* Cash Check Visa Mastercard Amex Discover Paypal Company Description & Keyword Info This section is very important! The information collected here helps us determine the best keywords for your client's business/industry/niche so please be as complete as possible!Give us a description of the business*For example what products or services are provided; how these products or services are delivered.Primary Media Contact / Author*Give us the Top 10 Keywords you think people will search for when looking for a business like this*These are the keywords you think a prospect would search for in Google when looking for products or services your client offers.Describe the Ideal Customer for Your Client*Demographics like age, sex, marital status, income level, etc. are great but also include a short narrative of who the typical customer is so we can truly understand the target audience.What 2-3 things do you does your client do better than their competition?What are other cities/zip codes (within 10 miles of your business) that you'd like to rank for, other than your main city?* Account Login Information To create your client's business listings, we need to know the account info if they have an existing Gmail, Yahoo or Hotmail email account.Does the client have a Gmail Account?*YesNoUsername*Password*Does the client have a Yahoo email account?*YesNoUsername*Password*Does the client have a Twitter account?*YesNoUsername*Password*Does the client have an Instagram account?*YesNoUsername*Password*Do you have a Linked In account?*YesNoUsername*Password*Does the client have Facebook page for their business?*YesNoIf yes, please add [email protected] as an admin of the business page. Do you have your own Vendasta account to be used?*YesNoDo you have your own Quantum Newswire account to be used?*YesNoIf yes, please provide login information.Username*Password*Attach the Company Logo and any other relevant images* Drop files here or CAPTCHAPhoneThis field is for validation purposes and should be left unchanged.
