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 Afghanistan Aland Islands Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bonaire, Sint Eustatius and Saba Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory Brunei Bulgaria Burkina Faso Burundi Côte d'Ivoire Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo Cook Islands Costa Rica Croatia Cuba Curacao Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic East Timor Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands (Malvinas) Faroe Islands Fiji Finland France French Guiana French Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Heard Island and McDonald Islands Holy See Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Isle of Man Israel Italy Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati Kosovo Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macao Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia Moldova Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island North Korea Northern Mariana Islands Norway Oman Pakistan Palau Palestine Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Puerto Rico Qatar Reunion Romania Russia Rwanda Saint Barthelemy Saint Helena, Ascension and Tristan da Cunha Saint Kitts and Nevis Saint Lucia Saint Martin (French part) Saint Pierre and Miquelon Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Sint Maarten (Dutch part) Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia and the South Sandwich Islands South Korea South Sudan Spain Sri Lanka Sudan Suriname Svalbard and Jan Mayen Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Timor-Leste Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States United States Minor Outlying Islands Uruguay Uzbekistan Vanuatu Vatican City Venezuela Vietnam Virgin Islands, British Virgin Islands, U.S. Wallis and Futuna Western Sahara Yemen Zambia Zimbabwe 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 upload 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 [email protected] 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
