Client Intake Form
Business Information
Business Name
(Required)
Business Phone
(Required)
Business Email
(Required)
Business Website (enter N/A if none)
Business Address (official address)
(Required)
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Contact Information
Contact Name
(Required)
Contact Email
(Required)
Contact Phone
(Required)
Emergency Contact Name
(Required)
Emergency Contact Phone
(Required)
Relationship
(Required)
Domain Name Register
This information relates to the company where you registered your domain name eg: GoDaddy, Namecheap, 1and1.
Domain Login URL
Domain Login Username
Domain Password
Hosting Details
This information relates to the company that hosts your website, eg: GoDaddy, Bluehost, Siteground.
Hosting Login URL
Hosting Login Username
Hosting Password
WordPress Website
Please provide us admin access if you have a WordPress site or create an admin user (lynadmin) with the email
[email protected]
WordPress Login URL
WordPress Login Username
WordPress Login Password
Comments
Please tell us any additional details we need to know. (e.g. additional contacts, current webmaster additional emails, contacts, etc.)
72288
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