In-Take Form Please complete this form to help us fully understand your requirements. GADs | GMB Please select relevant campaign Google Ads Phone Calls Only ( No website Required ) Do you have Google My Business account already setup? Yes No Name * Phone * Address Address Address Address City City State/Province State/Province Zip/Postal Zip/Postal Country AfghanistanAland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBruneiBulgariaBurkina FasoBurundiCôte d'IvoireCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCook IslandsCosta RicaCroatiaCubaCuracaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland Islands (Malvinas)Faroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestinePanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarReunionRomaniaRussiaRwandaSaint BarthelemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint Martin (French part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint Maarten (Dutch part)SlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUnited States Minor Outlying IslandsUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe Country Email associated with Google My Business * What is your target monthly budget? What are the main keywords you want to target? Please indicate at least 5-10 keywords (one per line) General Comments and Requests (i.e do you have any special offers to incentify browsers to visit your site?) i.e. XX% off, give aways, free quote, guarantees, unique selling features, lowest prices, same day delivery, 24 hour service, etc. Business Name * Primary Mailing Address (Not a PO Box) * Home Based Business? * Choose an optionYesNo Where do you serve customers? * Choose an optionAt my locationAt clients locationBoth Please Provide a Business Description * Primary Business Working Hours (Please check all days including Sat & Sunday if applicable) Monday Tuesday Wednesday Thursday Friday Saturday Sunday Monday Timings 121234567891011 : 0030 AMPM Tuesday Timings 121234567891011 : 0030 AMPM Wednesday Timings 121234567891011 : 0030 AMPM Thursday Timings 121234567891011 : 0030 AMPM Friday Timings 121234567891011 : 0030 AMPM Saturday Timings 121234567891011 : 0030 AMPM Sunday Timings 121234567891011 : 0030 AMPM What are the top 5 cities and/or counties you serve in your local community? Business Phone Number * Web address List 1 primary service & 3 secondary categories with brief description of your service (Max 300 characters) * Visit URL to see categories https://pleper.com/index.php?do=tools&sdo=gmb_categories What email address should we use to transfer Ownership of the Google listing once it has been verified? * A logo file (Requires a minimum of 250 X 250 pixels in PNG or JPG format) | 3-5 good pictures that give potential clients an impression of your business. Drop a file here or click to upload Choose File Maximum file size: 4MB Company Name * Contact Person * Address * City, State, Zip * Phone * Email * Website address: * Are there other decision makers? Please specify * Please specify the website pages you wish to promote (one URL per line) Who are your top 3 competitors? (one URL per line) Tick the goals that you want to achieve for this campaign Calls Leads Sales Web Traffic Other Please specify any products/services that you specifically do not want to promote? Have you created an account in Google Adwords? Yes No If you already have an account on Google Adwords please send campaign access to my email info@pirsem.com with administrative access level. Yes No What are the seed/main keywords for this site? Please indicate at least 5-10 keywords (one per line) What is your target daily budget? What is your target monthly budget? Please specify all target country & cities for this campaign (one per line) Please specify locations (country/cities) you wish to exclude What is your target maximum budget/bid per click? Are you open to other strategies outside AdWords? Please check the items applicable Facebook ads General Comments and Requests (i.e do you have any special offers to incentify browsers to visit your site?) i.e. XX% off, give aways, free quote, guarantees, unique selling features, lowest prices, same day delivery, 24 hour service, etc. If you are human, leave this field blank. Submit
