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PMG Contact Information

Contact Name*

First Last

Contact Email Address*

Contact Phone Number*

Business Information

Business Name*

Business Phone Number*

Business Address*

Street Address City State ZIP Code

My Billing Address Is Not The Same As Business Address

Billing Address*

Street Address City State ZIP Code

Please Leave Blank If Billing Address is Same As Business Address.

Business Contact Information

Contact Name*

Contact Phone Number*

Contact Email Address*

Additional Comments

PMG Request Forms

Select Services*

New Website Project
New SEO Project
New Pay-Per-Click Project
New Nearby Now Project
New Logo Design Project
New Social Media Design Project
New Media Planning & Buying

New Website Request Form

Website Design:

Please provide me a design concept
I have a Design I will provide (Please upload your PSD files to our Basecamp)

Our custom website packages include two custom designed page templates, usually the home and one interior page. Each additional custom design is $200. Please select the total number of pages you would like designed. Please allow one extra day on the promised turn-around per each additional page.

Emails & Website Hosting

Does the customers currently have a website?

Yes
No

Domain to be used for new site if different from live. (http://www.example.com)

Do you have emails connected to your current website? (ex. name@yourwebsite.com)

Yes
No

Website Design Overview

Please be as accurate as possible.

Would you like us to use your logo colors?

Yes
No
I don't have logo

If you don't have a logo, you must provide colors we will use. (refer to www.colorlovers.com for HEX#).

Please give us a brief overview of the following:

Describe the type of clients you provide services for.

Please list some of the websites you like

What are 3 or 4 main things you want visitors to see on your home page?

Special Instructions

If you have a logo please upload the file below.

Max. file size: 256 MB.

Our Terms

Please read the below carefully.
I understand & agree the following items are not included.*

Logo design
All written content
Photography services (photo editing, re-touchin, etc.)
All necessary login information to make the website live and connected to the provided domain.

New Pay-Per-Click Request Form

Monthly Budget:

Client Goal/Expected Conversions (be specific):

Products / Services (if multiple prioritize based on budget):

Top 3 Differentiators (years of experience,free shipping,promos,24/7,etc):

Sample Keywords you have in mind for campaign?

Target Locations:

Any Special Notes:

Do you have some idea of what you'd like your ad to say?

Landing Page/URL:

Expected activation date:

New Nearby Now Request Form

Company Email

A general corporate email address for the company.

Company Phone

The primary public telephone number for the company.

Company Logo

The URL for the company logo. If you do not have the logo available at a URL, please email to

Or you can upload your logo

Max. file size: 256 MB.

New Logo Design Request Form

Please be as specific as possible. Include any and all ideas, requirements, and specification as well as the intended use of the logo (webiste, print, letterhead, signage, etc.)

Exact name you would like to be used in your logo:

Website address if applicable:

What will be the tag line if any?

Describe your field of business.

What/Who is your target clientele?

What colors would you like us to use in your logo?

Do you want the logo to be text-only, graphic-only, text and graphic together?

Text Only
Graphics Only
Text & Graphics Both

Please describe any special type of graphic/icon you desire

Describe any ideas you have in mind for your new logo.

What should come to your customers mind when they see your logo?

Who are your competitors and what do you think about their logos?

Please provide reference images or links to logo styles you like:

Anything you do not want to see in your logo?

List 3 different items you see being used to represent your company (i.e. person walking, tree, house, etc.)

Attach File

Max. file size: 256 MB.

New Social Media Design Request Form

Social Banner Design Instructions

Please be as specific as possible. Include any and all ideas, requirements, and specification as well as the intended use of the logo (webiste, print, letterhead, signage, etc.) You will receive one concept for each of the following platforms: Google+, Youtube, Facebook, LinkedIn and Twitter.

Describe your Company/Business and Target Audience:

Describe your preferred color scheme:

Information, wording & content to include in your banner header design:

Links to banner header & graphics that you would like us to look at as an example for what style you are looking for:

Additional thoughts & comments for us to consider:

Upload Logo Files And/Or Additional Files To Include In Design:

Max. file size: 256 MB.

SEO - New Request Form

Local Business Checklist

What is the name of your client?

Is your client`s website on the Wordpress platform?

Yes
No

Before We Start

We treat your data with the utmost care we will not share your clients data with 3rd parties or store any payment information.

Lets Get Started!

The website address of your client`s business

Wordpress username

Password

Please give us your Cpanel Details

Please include Username, and Password

Does the clients website have any of the following accounts setup? Please tick

A seperate gmail account specifically for your website
Google Analytics
Webmaster tools
Google My Business Account
None of the above

Add your agency and customers local IP addresses here. Click the + to add more than one IP address.

We add these to Google analytics so we aren't skewing data

Click Here For Your IP

Can you setup a domain email for your client specifically for citation building? - Example (listings@yourdomain.com)

Yes
No

Please add the domain email here - Example (listings@yourdomain.com)

Password for the above domain email

It is best if the password uses at least one capital letter and at least one number.

Please provide the URL to login to the domain email (example www.thisispmg.com/webmail) or https://login.secureserver.net/

Preferred Username

If you have any specific requirements for the username used when registering the business, please, specify it. If not, we will create one for you.

Please give preferred password

Please give a preferred password, if not we will create one for you.

Please give preferred password

Please give a preferred password, if not we will create one for you.

Name of the business. This is the official/registered name of your client`s business and should also match exactly how it appears on your website.

Name Of The Owner/Face Of The Business

Date Of Birth Of Owner/Face Of Business

Some verifications such as Yahoo and Google require this

The client`s permanent business address, It should appear exactly as if written on a standard addressed envelope and exactly as it appears on your client`s website ( this must not change)

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Client`s main phone number to be listed publicly and match the website contact number (this must not change)

Please, do not add call tracking numbers or toll-free numbers here, unless they are your actual main phone numbers that you use to conduct business.

What is the Business First and Foremost? (try tell us in 1-4 words)

We are looking for a seed word that we can use to scrape other relevant categories from Google My business

What is the Business First and Foremost? (try tell us in 1-4 words)

Previous Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Add all previous telephone numbers for your client (if applicable)

Does the client use this phone number for any other locations or other businesses you own?

Yes
No

What is the email your client presents to the public- Example (info@yourbusiness.com)

Does your client`s business have a service area?

Yes
No

What is the radius of your client`s service area in miles?

Please enter a value between 1 and 1000.
Bear in mind, this is a local listing. We are aiming for a maximum of a state wide radius depending on the business. ( We initially focus on the town/city your client is in)

Does your client`s business have set opening times?

Yes
No
Yes but we also work outside these hours

Your client`s business payment options

Discounts and specials offered

If your client offers some discounts and/or special offers that are valid for a long period of time, please, specify them here. For example: 10% senior discount.

Please input the You Tube channel URL if you have one

List all your clients products/services, THESE ARE NOT KEYWORDS PLEASE DONT write a long list of things your client wants to rank for. Instead just tell us the actual services they offer and break these down as much as you can, the more specific the better

Please only add one product/service per line with the area at the end. Example - ``Head gasket repair Orlando``

Please give the top 5 most relevant services for comparison against the local competition (one service per line)

We tend to find the 80/20 rule applies to most businesses, what are the 20% of your clients business services or products that produce the 80% of the profits?

Column 1	Column 2	Column 3

e will use the information to prioritize these products/services and make them more prominent

These are some information items specific to service-based businesses. If your clients business is such, please, fill in all the fields

Does the client have warranties?

Yes
No

Is the client bonded?

Yes
No

Is The client Insured?

Yes
No

Does your client already have a Google + business page description? if not add one here. Make it unique to the rest, this is your most important listing.

Descriptions Under 100 characters (for citations)

Some sites only allow a limited number of characters for the description field. Keep the medium description under 350 characters. You can try to gracefully include keywords, but keyword spamming this field isn't necessary and isn't going to help you. Keep it human readable.

Description up to 1500 characters (for citations)

Some sites allow for a much larger number of characters in the description field. Keep the large description under 1500 characters.

Annual Revenue

Some websites ask for this. A good example is Manta.com, where if you do not specify the annual revenue you cannot get a 100% completed profile.

Slogan/Tagline (Up to 50 characters)

Please, keep the slogan or brand tagline under 50 characters, if possible.

Associations Participation

If your client is part of any professional organizations, please, specify them. For example: County Chamber of Commerce; BBB.

New Media Planning & Buying

Additional Business Information

Business Website:

What is the business's main competition?

What is the Geographic target for the campaign?

Does the business want to expand to other areas? (If yes, please list additional areas)

The business currently services what markets?

What products or services does the business currently offer and/or want to advertise?

The business currently services what markets?

What products or services does the business currently offer and/or want to advertise?

What dates will the campaign cover?

What is the primary objective of the campaign? (Branding, generate sales, event promotion, etc)

What are the demographics of the targeted audience? (Gender, age, etc)

Are there any particular stations on which the client prefers to air?

What is the campaign budget?

Is the client eligible for any co-op funding? If so, with what vendor(s)?

Does the client currently have or ever used a jingle?

Down to Business (Media Vendors)

What is the businesses total advertising budget allocated to all media channels?

How does the business currently track effectiveness of advertising?

What media channel does the client feel is most effective?

What media vendors does the client currently use?

YP
HIBU
Television
Radio
Billboard
Print
Online
Others

Other Media Vendors Names

What media vendors has the client authorized PMG to manage?

YP
HIBU
Television
Radio
Billboard
Print
Online
Others

Other Details

What is the Letter of Authorization date?

Print directory (Let’s get the details.)

Is the business using Print Directories? (If yes, list each vendor and the monthly spend.)

Is the business using YP? (If yes, list the username & password for http://adsolutions.yp.com.)

List the YP Rep's Contact Information.

Is the business using HIBU? (If yes, list the username & password for https://business.yellowbook360.com/site/.)

List the HIBU Rep's Contact Information.

Please list any comments client made about Print Directories.

TV (Lets get the details.)

Is the business using TV? (If yes, list each station and the monthly spend.)

List the TV Rep's Contact Information. (List each station being used.)

Please list any comments client made about TV.

Radio (Lets get the details.)

Is the business using Radio? (If yes, list each station and the monthly spend.)

List the Radio Rep's Contact Information. (List each station being used.)

Please list any comments client made about Radio.

Billboard (Lets get the details.)

Is the business using Billboard? (If yes, list each vendor and the monthly spend.)

List the Billboard Rep's Contact Information. (List each vendor being used.)

Please list any comments client made about Billboards.

ONLINE (Lets get the details.)

Is the business using Online advertising? (If yes, list each vendor and the monthly spend.)

List the Online Vendors & Rep's Contact Information. (List each vendor being used.)

Please list any comments client made about Online advertising.

Other (Lets get the details.)

Is the business using Other advertising? (If yes, list each vendor and the monthly spend.)

List the Vendors & Rep's Contact Information. (List each vendor being used.)

Please list any comments client made about Other advertising.

Additional Comments

Please provide any additional comments.