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First Name
Last Name
Email
Phone Number
Address
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Current Website / Social Media Information
Do you currently have a website domain?
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No
If yes, what is it?
Do you currently have web hosting?
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No
If yes, who is it?
Do you have a Logo?
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If yes, Upload the Image here
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Do you have Corporate colors?
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If yes, please list the RGB or HEX code(s) or description
If you have an existing website, what is your current URL
On your Current website, what aspects work well & why?
On your Current website, what is NOT working well & why?
Provide any Social Media links you have that you would to include on your new website:
Current Website Build
Do you have any existing content you would like to use?
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If yes, upload your content here:
Website Target Audience: Check all that apply
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Primary Agent Full Name
Primary Agent Title
Primary Agent Email
Primary Agent Photo
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Primary Agent Bio & Social Media links
Please list any other team members' names, short bio, unique email, & social media links:
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Home
Our Products
Life Insurance Quoters
Consumer Landing Page
Download our Flyer
Agent Mobile Quoter
NY Shield Act 2020
What is the NY Shield Act
NY Shield Act FAQs
Managed Websites
Custom Websites
Website Planner & Questionnaire
Email Setup Questionnaire
Email Package
Business Email Plan
Domains
Register Domains
Transfer Domains
Premium Domains
Contact Us
Client area
Support Ticket
Talk with Us
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