Website Design Only Intake Form We would love to hear from you! Please fill out this form and we will get in touch with you shortly. Step 1 of 4 25% Basic Business and Contact InformationName of Company* Public Business Phone Number* Who would you like us to contact?* First Last Best way to contact you?* Cell Phone Office Phone Text Message Email Best contact #/email address?* Best day of the week to contact you?* Monday Tuesday Wednesday Thursday Friday Best time of day to contact you?* : Hours Minutes AM PM Physical Business Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Can we publish this business address publicly?* Yes No Billing Address* Same as above Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Basic Website InformationList Your Current Website URL*If you do not have a website URL yet, please write "Need Website URL". Do you have multiple websites?* Yes No If you do have multiple websites, please list their URLs here. Social Media InformationFacebook URL TwitterUsernameYelpURLYouTubeChannel URLInstagramUsernameLinks Additional Social Media ChannelsPinterest, Snapchat, Houzz, etc. Technical Website InformationDomain RegistrarYour registrar will be something like GoDaddy, Network Solutions, etc...Registrar WebsiteUsernamePasswordWeb Host InformationHosting ProviderUsernamePasswordWebsite CMS LogInLink to LogInUsernamePasswordWould you like to host your site with TrustWorkz (Recommended)?*YesNoNot sureWe provide managed hosting for free to our active TrustWorkz clients, which means that we will take care of important updates to your WordPress site as they are available and after we have tested them. Security is extremely important to us, and our managed hosting provides you with extra security features and protection. Your site will be hosted on our dedicated server. Who would you like to host your email? (Emails ending in the @YourDomain.com)*TrustWorkzGoogle Apps for BusinessOffice 365 or otherI don't want emails using my domainNeed more informationI already have emails set up through Google or Office 365If you want your email(s) to appears like example@yourdomain.com, then please make a selection. We suggest Google Apps for Business (see pricing: https://gsuite.google.com/pricing.html). The basic plan includes access to all their apps and tools, 30GB of cloud storage, and great email service. And, you have control of your email at all times. We can set this up for you for a one time charge of $35, or you can do it yourself for free (suggested - it's very easy). OR you can host your email with us for $6/month (per email). Website Design InformationEmail (where contact form notifications from website should be sent)* List 2 to 3 websites that you REALLY like, and a short description of why.Please list 2 to 3 websites that you DON'T like, and a short description of why.Is there any special functionality you are looking for on your new website?Upload Logo FileMax. file size: 128 MB.We prefer original logo files with .eps or .ai file extensions. A PNG image file will work as well. Your logo will look best without a white background. We can edit your logo for an additional fee. If you do not submit a logo, your business name will go at the top of your website in plain text.Additional Logo FileMax. file size: 128 MB.Additional Logo File (2)Max. file size: 128 MB.Do you wish to transfer your current content over to your new site?* Yes No Upload any additional content here in Word Document formatMax. file size: 128 MB.Upload a ZIP file of any additional content created in Word Document formatMax. file size: 128 MB.Please list all of the pages you would like to have in the navigation of your new siteDo you currently use an email marketing service (Constant Contact, MailChimp, etc)NoYesEmail Marketing CredentialsPlease provide your log in credentials so that we can properly integrate your email marketing service into your new website. Service (MailChimp, Constant Contact, etc.)UsernamePassword Δ
