Care Plan Audit Intake Form
Secure Intake Information
Newman Web Solutions
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Care Plan Audit Intake Form
Congratulations on taking the first step towards a website that accurately represents your business to the world. We are excited to meet with you for our discovery process and take the first step towards helping you achieve your online marketing goals.
Company Information
This information is crucial, in particular to the maintenance and design of your website.
Contact Name
*
First
Last
Company Name
*
Contact Email
*
Contact Phone
*
Address
*
Street Address
Address Line 2
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Company Website URL
*
WordPress Information
If you already have an existing WordPress site, please provide admin access below. You can create an admin user for us Username senadmin or provide us an existing one and we will create one for us.
WordPress Login URL
*
Where is it you log into your WordPress website?
WordPress Username
*
What is the WordPress username to login to your website? If you prefer not to use yours, you can create a username: senadmin and email address: sam@newmanwebsolutions.com
WordPress Password
*
What is the password to login to your WordPress website?
Hosting Details
This information relates to the company that hosts your website, eg: GoDaddy, Bluehost, Siteground. This will help us look for any malicious files in the backend.
Hosting Company
Hosting URL (cpanel login)
Hosting Username
What is the username to login to your website host?
Hosting Password
What is the password to login to your website host?
COMMENTS / ADDITIONAL INFO:
Please let us know anything else in particular you would like us to also know about you, your company or your website (e.g. additional contacts, current webmaster additional emails, contacts, etc.)
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