New Client Intake

Enter Company Details Below

Product Purchased: *

Other Product Name

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:

Other Locations Address:

Paid:

Street Address:

City:

State:

Zipcode:

Add More

Other Locations Address 2:

Paid:

Street Address:

City:

State:

Zipcode:

Add More

Other Locations Address 3:

Paid:

Street Address:

City:

State:

Zipcode:

Add More

Other Locations Address 4:

Paid:

Street Address:

City:

State:

Zipcode:

Add More

Other Locations Address 5:

Paid:

Street Address:

City:

State:

Zipcode:

Hours of Operation*24/7 ecommerce

From:

To:

From:

To:

Add More

Bsiness Hours Start Day From:

Bsiness Hours End Day To:

Bsiness Hours Start Time From:

Bsiness Hours End Time To:

Add More

Bsiness Hours Start Day From:

Bsiness Hours End Day To:

Bsiness Hours Start Time From:

Bsiness Hours End Time To:

Add More

Bsiness Hours Start Day From:

Bsiness Hours End Day To:

Bsiness Hours Start Time From:

Bsiness Hours End Time To:

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:

Google Page Location 1:

Gmail/ Google My Business Page 1:

Username:

Password:

Add More

Gmail/ Google My Business Page 2:

Username:

Password:

Add More

Gmail/ Google My Business Page 3:

Username:

Password:

Add More

Gmail/ Google My Business Page 4:

Username:

Password:

Add More

Gmail/ Google My Business Page 5:

Username:

Password:

Bing Logins:

Bing Page Locations:

Bing link 1:

Username:

Password:

Add More

Bing link 2:

Username:

Password:

Add More

Bing link 3:

Username:

Password:

Add More

Bing link 4:

Username:

Password:

Add More

Bing link 5:

Username:

Password:

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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