Detailed Client Intake Form General InformationBusiness Name* Hours of Operation* Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Is the address above public information and can it be posted online? Business Phone*Business Email*Business Social Media Accounts Website InformationCurrent Site* Domain And Where It Was Purchased From* Number Of Pages For New Site*Pages Home About Contact Services Other Names Of Other Pages Logo / DesignDo you have a logo?* Yes No Slogan What are your business colors? If no colors are preferred, what are you trying to convey? (loyalty, power, etc) Are there any colors or imagery that you do NOT want specifically in your logo or other design work? PhotosHow will you be submitting your photos? Email Dropbox Use images on Current Website Use images on Facebook Business ServicesPlease list below services and products you offer. Also, please provide a short description for each service/product to let customers know why these services are important to them:Please list Cities and Areas you Provide Service to: Payment methods you accept: Credit Debit Paypal Other If other, list payment methods: Do you want to use any product/vendor logos on your website? How do you want your clients to contact you? Phone Email Other Other contact methods What is your experience or history in this line of work?Personal InfoA short, clear, concise description of your company, vision, and guiding principles:What advantage does your company bring to the table, and what makes you standout?What are the potential barriers to your business success, and how do you plan to address them?What are the main calls to action?HiddenBrand Touchpoints Word of Mouth Networking Other HiddenIf other, please list additional brand touchpoints. Please give some adjectives that describe your company? (friendly, hard working, serious): HiddenApproach: What is the imagery that best symbolizes your brand? If you were a car what would you be and why? (BMW, Mercedes, Ferrari, Honda, Jeep)at best symbolizes your brand? PhoneThis field is for validation purposes and should be left unchanged. Δ
