Client 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 State ZIP Code
Company Website URL*
Hosting Details
This information relates to the company that hosts your website, eg: GoDaddy, Bluehost, Siteground.
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?

Domain Name Registration
This information relates to the company where you registered your domain name eg: GoDaddy, Crazy Domains, 1and1.
Domain Registration
Where is your domain name registered? ie. GoDaddy
Domain Register URL
Domain Register Username
Whate is your username to login to your domain name registrar? They will have sent you this in an email when you first registered the domain name.
Domain Register Password
What is your password to login to your domain registrar? They will have sent you this in an email when you first registered the domain name.

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?
WordPress Password
What is the password to login to your WordPress website?

FTP Details
This information relates to the FTP accounts for your existing website if you have it.
FTP Server Address
What is the FTP address of your current website?
FTP Username
What is the FTP username to login to your website?
Password
What is your FTP password to login to your website?
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.)

New Client Information