Web Quote Page - By Salterra Web Services

Do you Have a Current Website?*

No
Yes

Current Web Address (URL)*

Current Domain & Hosting Provider*

How may we assist you? (check all that apply)*

Web Design
Graphic Design
Logo Design
SEO (Internet Marketing)
PPC (Pay Per Click)
Link Building
Reputation Management
Penalty/Malware Challenges
Content Writing

New / Remodel Website

What would you like your website to do? (Check all that apply)*

Shopping Cart System
Search Engine Optimization
Play Video / Audio
Appointment Setting
Blog writing and commenting
Social Media setup
Pay Securely On-line
Password Protect Areas
Special Sign-up / info Forms

Favorite Colors?*

Go Live Date*

Upload your Logo

List any websites you like here

Website 1	Website 2	Website 3

Internet Marketing (SEO) / Link Building

List top 3 areas*

Area 1	Area 2	Area 3

city/state/country

List top 3 Keyphrases*

Keyword 1	Keyword 2	Keyword 3

Keywords you want to rank for

Social Media Accounts Setup

Facebook	Twitter	Google+

URL of ALL your Social media accounts

Please tell me about your goals for the site

Please tell me about any problems you are having with your site

Graphic / Logo Design

Tell Us What You Are Looking For*

Upload any images or drawings you have

Drop files here or

Paid Advertising (PPC=Pay Per Click)

List top 3 areas*

Area 1	Area 2	Area 3

city/state/country

List top 3 Keyphrases*

Keyword 1	Keyword 2	Keyword 3

Keywords you want to rank for

Tell me about your goals for this campaign Including # of leads per month you are wanting

Reputation Management

Describe the Issue*

Remove Search Result(s)
Push Down Search Result(s)
Protect Online Reputation
SEO (Search Engine Optimization)
De-Index Search Reults
Improve Online Reviews

What Search Term Did You Use?*

How did you find the bad review

What Browser Did You Use?

Internet Explorer, Chrome Firefox

When Was The Last Time You Saw The Review?

Which Pages To Remove

RipoffReport
PissedConsumer
Complaintsboard
Thedirt
law360
complaints
scambook
scamgroup
Other

Which Review Sites to Improve

Yelp
Google
City Search
Angieslist
Homeadvisors

What have you done to improve or remedy your reviews

Penalty / Malware Challenge

How did you find out you have a challenge?*

Found it when I went to the site
Search Engine Notification
Someone Told Us
Our Hosting Company

Check ALL That Apply

Do You Have Access to the Web Files or Back-end of the website?*

No
Yes
Not Sure

Other Comments

Are You Finished With The Form?*

No, I Don't know what to do
Yes

What is your current budget?*

How Did you hear about us*

Web Search
Social Media
Other Ad
Referral

Who Referred You?*

Name*

First Last

Company Name*

Phone

Email*

Questions or Comments

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