New Client Intake

Enter Company Details Below

Product Purchased: *[group other-product]Other Product Name [/group]

Purchase Date:

Interval: *

Current Business Name: *

Previous Business Name(s)

Business Owner Name:

Best Contact Person Name:

Best Contact Person Email:

Best Contact Person Phone: *

Street Address* Current Business Address:* City* State* Zipcode* Country*

Previous Business Address(es):City State Zipcode Country

Current Business Phone Number:*

Previous Business Number(s):

Year Business Established:

Total Number of Employees:

Other Locations:

[group other-locataion-box clear_on_hide]
Other Locations Address:

Paid:

Street Address:

City:

State:

Zipcode:

Add More
[/group]

[group other-locataion-box2 clear_on_hide]
Other Locations Address 2:

Paid:

Street Address:

City:

State:

Zipcode:

Add More
[/group]

[group other-locataion-box3 clear_on_hide]
Other Locations Address 3:

Paid:

Street Address:

City:

State:

Zipcode:

Add More
[/group]

[group other-locataion-box4 clear_on_hide]
Other Locations Address 4:

Paid:

Street Address:

City:

State:

Zipcode:

Add More
[/group]

[group other-locataion-box5 clear_on_hide]
Other Locations Address 5:

Paid:

Street Address:

City:

State:

Zipcode:

[/group]

Hours of Operation*24/7 ecommerce

From:

To:

From:

To:

Add More

[group bhour2]

Bsiness Hours Start Day From:

Bsiness Hours End Day To:

Bsiness Hours Start Time From:

Bsiness Hours End Time To:

Add More

[/group]

[group bhour3]

Bsiness Hours Start Day From:

Bsiness Hours End Day To:

Bsiness Hours Start Time From:

Bsiness Hours End Time To:

Add More

[/group]

[group bhour4]

Bsiness Hours Start Day From:

Bsiness Hours End Day To:

Bsiness Hours Start Time From:

Bsiness Hours End Time To:

[/group]

Current Business URL:*

Previous Business URL(s):

Business Owner Email:

Elocal Rep Email:*

Keyword 1:*

Keyword 2:*

Keyword 3:*

Keyword 4:

Keyword 5:

WP Logins:

Username:

Password:

Cpanel Logins:

Username:

Password:

Google Analytics Logins:

Username:

Password:

Other Logins:

Username:

Password:

Gmail/ Google My Business Page:

[group galoc-box1 clear_on_hide]
Google Page Location 1:

Gmail/ Google My Business Page 1:

Username:

Password:

Add More
[/group]

[group galoc-box2 clear_on_hide]

Gmail/ Google My Business Page 2:

Username:

Password:

Add More
[/group]

[group galoc-box3 clear_on_hide]

Gmail/ Google My Business Page 3:

Username:

Password:

Add More
[/group]

[group galoc-box4 clear_on_hide]

Gmail/ Google My Business Page 4:

Username:

Password:

Add More
[/group]

[group galoc-box5 clear_on_hide]

Gmail/ Google My Business Page 5:

Username:

Password:

[/group]

Bing Logins:

[group bingloc-box1 clear_on_hide]
Bing Page Locations:

Bing link 1:

Username:

Password:

Add More
[/group]

[group bingloc-box2 clear_on_hide]

Bing link 2:

Username:

Password:

Add More
[/group]

[group bingloc-box3 clear_on_hide]

Bing link 3:

Username:

Password:

Add More
[/group]

[group bingloc-box4 clear_on_hide]

Bing link 4:

Username:

Password:

Add More
[/group]

[group bingloc-box5 clear_on_hide]

Bing link 5:

Username:

Password:

[/group]

Facebook:

Username:

Password:

Twitter:

Username:

Password:

Instagram:

Username:

Password:

Yelp:

Username:

Password:

LinkedIn:

Username:

Password:

YP:

Username:

Password:

Other Important Logins:
Notes:
Pictures are required, You can use examples of work, logos, team pics, etc.
The ideal size for photos is 600x450.

*By clicking submit and sending your information, One Stop Emails will consider this information to be true and correct as of the submission date and will use the information for all directories and verifications. eLocal Solutions does not claim responsibility for incorrect information after submission. Changes in the information after submission will be subject to a change fee. This fee will be determined on a case by case basis and will be due and payable upon start of the work. No exceptions will be made to this policy.

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New Client Intake

Enter Company Details Below

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