Intake Form – Local Business Information


LBI (Local Business Intake) Form

The Intake Form will give us all the information we need to perform your SEO work effectively.

Please fill in every field as each one has importance in ranking your website.

Please enter as much information as you can. We will use this information to create or improve your online listings.

Basic Business Information

Company Name: *

Address: *

Street Address


State / Province / Region

ZIP / Postal Code


Supplementary Address Information

Address 2:

Street Address


State / Province / Region

ZIP / Postal Code


Main Contact Information

Phone: *


Toll Free Number:

Skype Number:

Website: *

Profile Email / Web Mail / Business Email:

Business Makeup

Business Type / Category: *

Products / Services: *

Products / Services: *

Business / Office Hours:

Days of Weeks: *

Hours of Day: *


Payment Methods Accepted:

Highlight all that apply: *

Other payment methods:

Other Business Information

In Business Since: *

Primary Keyword / Tags: *

Business Description - Short (200 Characters Max): *

Business Description - Long:

Digital Assets

Upload Your Business Logo Here:

Business Photos (Minimum of 10 - limit per file of 1mb): Upload Here

Photo 1:

Photo 2:

Photo 3:

Photo 4:

Photo 5:

Photo 6:

Photo 7:

Photo 8:

Photo 9:

Photo 10:

Video URL's on YouTube, Vimeo, etc. (Try to give 5 Video URLs)

Video 1:

Video 2:

Video 3:

Video 4:

Video 5:

Additional Information

Tag Line / Business Slogan:

Specialties (exclusive products, areas of expertise):

Cities Served / Counties Served / Areas Served:

Language Spoken:

Wi-Fi (Yes/No):

Parking Available (Yes/No):



Coupons & Specials (Get more business by adding an offer or discount. You can update or delete your coupon at any time):

Offers (for example: - 20% off all haircuts, Expires: Oct 15, 2013):

Brand Names Carried:

Affiliations (Member Sites / Trade License No., Chamber of Commerce etc...):

Social Media Page URLs (Face Book, Twitter, Blog):

Owner Information

Name *

Position / Job Title: *

Owner / Contact Person Gender: *

Owner / Contact Person Date of Birth: *

Owner / Contact Person Bio:

Owner / Contact Person Location:

Street Address:


State / Province / Region:

ZIP / Postal Code:


Owner / Contact Person Photo:

Website Information

Website Login info: username/password *

Google Business Login: *

Google Business Url : *

Please create an email account e.g. [email protected] for us to use.
Enter the name of the email account here:

Note: Previous Business Name, Address & Phone for editing business: (If business was submitted many times by you or other SEO company worker)