New Client Intake

1
Tell Us About You & Your Business* This field is required.This is the required information needed to properly set you up in our system
First Name
Last Name
Busines Name
Email
Phone
Street Address
City, State, Zip Code
2
Please list your main services & sub-servicesExample - Neurotoxins (main) Botox, Dysport etc. (sub-service)
Main service # 1
List sub-niches
Main service # 2
List sub-niches
Main service # 3
List sub-niches
Main service # 4
List sub-niches
3
Please list the pricing of your services
4
Lead Information* This field is required.This is where you would like your incoming leads to go
Phone # for Leads
Email for Leads
Text # for Leads
5
Who are your TOP 5 online competitors?Please list their websites in order of competition.
6
Current Website Host Login Information * This field is required.Examples - Wordpress, Wix, Weebly, GoDaddy etc.
7
Current Domain Hosting Login* This field is required.Examples - Google, GoDaddy, Name Cheap etc.
8
Current Domain Hosting Customer #/Pin #* This field is required.*Only for GoDaddy. Please put NA for other accounts.
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Confirmed Business Hours* This field is required.We will use this to set up all citations to match your GMB
10
Social Media Account Links* This field is required.Please list the links to your profile below: Facebook, Instagram, Twitter, Linkedin, Youtube etc.
11
Industry Specialty Account Links* This field is required.Please list the links to your profile below: Houzz, Nextdoor, Yelp, BBB etc.
12
If you already have your Google My Business (GMB) set up, please login and send me a manager request: lisa@millionairemedspamarketers.com Instructions - https://support.google.com/business/answer/3403100?hl=en
Please type "YES" above once completed.
13
Please list (3)Company Differentiators How your business operates & why you stand out against your competitors?
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Please list (3) Service Differentiators How you deliver services & how it differs from your competitors?
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15
Who is your target demographic?What population are you trying to serve (ie. women 25-40 / makes 80k per year / divorced / lives a healthy lifestyle)
Gender
Age range
What are their interests / hobbies?
What's important to them?
16
How do you alleviate customers fears of doing business with you?* This field is required.
17
What is your business's mission, vision, and values?
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18
Preferred Monthly Reporting Check-ins
Preferred Day
Preferred Time
Preferred Email
19
Monthly, Quarterly, Yearly Revenue Goals
20
How would you rate this onboarding process?
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Simple
21
Please reference two business owners whom you feel may benefit from our services:We greatly appreciate any referrals you may share, but it is certainly not required :)
Full Name
Address
Contact Number
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Full Name
Address
Contact Number
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Address
Contact Number
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