New Client Form

Customer Information

Company Name*

Business Address*

Street Address Address Line 2 City State ZIP Code

Business Phone*

Contact Name(s)*

Contact Position (Owner, Manager, etc.)*

Contact Phone Number*

Contact Email(s)*

Email Address for Accounting/Billing Purposes*

Website URL(s)*

Primary Brand*

Factory Authorized*

Distributor*

Territory Manager*

Salesperson*

Please provide as much information as possible to help the IT team throughout the website build and SEO process.

Website Build Level*

SEO Product(s)*

Semantixs Level*

Website Hosting?*

Other Services*

Description of 'Other' Services

Geo Strategy*

Please follow up with the salesperson if this information is unknown. If the customer is not signing up for any SEO products, enter N/A here.

Industries to be targeted (HVAC, Plumbing, Electrical, etc.)*

Please follow up with the salesperson if this information is unknown. If the customer is not signing up for any SEO products, enter N/A here.

Any additional notes or special information about the campaign/client:

Attach Ranking Report

Attach PO*

Additional Attachments (Geo Strategy, etc.)