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J6MediaGroup.com - Client Intake Form
Fill in the details below so we can create your digital marketing proposal
* Indicates required question
Email
*
Record my email address with my response
Today's Date
*
MM
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DD
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YYYY
Full Name
*
Your answer
Phone Number
*
Your answer
Full Business Address
*
Your answer
Business Website URL
Your answer
Business Facebook URL
Your answer
Business Twitter URL
Your answer
Business Pinterest URL
Your answer
Business Instagram URL
Your answer
Business YouTube channel URL
Your answer
Client Google My Business (GMB) profile URL
Your answer
For your website do you need a NEW design or a Redesigned site?
*
I need a New custom site
I have a site, but needs to be Redesigned for fresh updated look
I am happy with my current site
I need help with security issues, backups and legal requirements for my site
Required
What is your budget for a website?
*
$500-$1,500 - Standard 5-Page based Theme template
$1,500-$2,500 - Semi-Custom 5-7-Page site with Additional plugins & features
$2,500-$4,500 - Semi-Custom 7-15 Page site with Extra 3rd party integrations, etc
$4,500-$7,500 - Semi-Custom 15+ Page site for Ecommerce, Online shops, Ordering, etc
Other:
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