Website Design + Insights Package Intake Form Step 1 of 5 20% Basic Business and Contact InformationName of Company* Public Business Phone Number* Who would you like us to contact?* First Last Best way to contact you?* Cell Phone Office Phone Text Message Email Best contact #/email address?* Best day of the week to contact you?* Monday Tuesday Wednesday Thursday Friday Best time of day to contact you?* : Hours Minutes AM PM AM/PM Physical 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 FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Can we publish this business address publicly?* Yes No Billing Address* Same as above 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 FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Basic Website InformationList Your Current Website URL* If you do not have a website URL yet, please write "Need Website URL".Do you have multiple websites?* Yes No If you do have multiple websites, please list their URLs here. Social Media InformationFacebookURLTwitterUsernameYelpURLYouTubeChannel URLInstagramUsernameAdditional Social MediaLinks to any additional social media channels you have already set up for your business such as Pinterest, Houzz, SnapChat Technical Website InformationGoogle AdWords Account Number(if available) Do you have a Google Analytics account?* Yes No Google AnalyticsPlease prove the username and password for the gmail account associated with your Google Analytics, if you already have an account set up. OR add '[email protected]' as a full rights user to your account. UsernamePasswordDomain RegistrarYour registrar will be something like GoDaddy, Network Solutions, etc...Registrar WebsiteUsernamePasswordWeb Host InformationHosting ProviderUsernamePasswordWebsite CMS InformationURL to Log InUsernamePasswordWould you like to host your site with TrustWorkz (Recommended)?*YesNoNot sureWe provide managed hosting for free to our active TrustWorkz clients, which means that we will take care of important updates to your WordPress site as they are available and after we have tested them. Security is extremely important to us, and our managed hosting provides you with extra security features and protection. Your site will be hosted on our dedicated server. Who would you like to host your email? (Emails ending in the @YourDomain.com)*TrustWorkzGoogle Apps for BusinessOffice 365 or otherI don't want emails using my domainNeed more informationI already have emails set up through Google or Office 365If you want your email(s) to appears like [email protected], then please make a selection. We suggest Google Apps for Business (see pricing: https://gsuite.google.com/pricing.html). The basic plan includes access to all their apps and tools, 30GB of cloud storage, and great email service. And, you have control of your email at all times. We can set this up for you for a one time charge of $35, or you can do it yourself for free (suggested - it's very easy). OR you can host your email with us for $6/month (per email). Website Design InformationEmail (where contact form notifications from website should be sent)* List 2 to 3 websites that you REALLY like, and a short description of why.Please list 2 to 3 websites that you DON'T like, and a short description of why.Is there any special functionality you are looking for on your new website?Upload Logo FileMax. file size: 1 MB.We prefer original logo files with .eps or .ai file extensions. A PNG image file will work as well. Your logo will look best without a white background. We can edit your logo for an additional fee. If you do not submit a logo, your business name will go at the top of your website in plain text.Additional Logo FileMax. file size: 1 MB.Additional Logo File (2)Max. file size: 1 MB.Do you wish to transfer your current content over to your new site?* Yes No Upload any additional content here in Word Document formatMax. file size: 1 MB.Upload a ZIP file of any additional content created in Word Document formatMax. file size: 1 MB.Please list all of the pages you would like to have in the navigation of your new siteDo you currently use an email marketing service (Constant Contact, MailChimp, etc)NoYesEmail Marketing CredentialsPlease provide your log in credentials so that we can properly integrate your email marketing service into your new website. Service (MailChimp, Constant Contact, etc.)UsernamePassword Directory Listing InformationDirectory Listing Admin*Email that you would like to be made an admin on your directory listing account. Business Description*Please write a short description including the name of your business, the city you are located in, your primary business services, and whom you cater to. Do clients visit your physical location, or do you provide service at theirs?* They visit my location I provide a service at their location Both Business Hours*MondayTuesdayWednesdayThursdayFridaySaturdaySunday 5-10 Photos of Your Business Drop files here or Select files Accepted file types: jpg, gif, png, jpeg, Max. file size: 30 MB, Max. files: 10. Payment Types Accepted Discover MasterCard Visa Cash Check Apple Pay Android Pay Financing
