Social Media Order Form

First Name *

Last Name *

Street Address 1 *
City *
State *
Postal Code *

Email *

Business Phone # *

Cell Phone #

Company Name *

Company Description

Company Slogan

Business Hours

Payment Types Accepted

Main City (must have a physical address above)

Most Important Keyword Phrase You Want to be Found on the Search Engine *

List 3 More Keyword Phrases For Your Business *

Website URL *

We need you to create a Gmail email account that we can use to setup your social media sites. Please go to www.gmail.com and create a new account using your business name. We will need both the email address and password to complete the work.

Gmail Email Address *

Gmail Password *

If you already have social media sites that you have created for your business that you would like to use with the Post Place, please provide the social media site, username and password.

Facebook Username

Facebook Password

Twitter Username

Twitter Password

Google Plus Username

Google Plus Password

Additional Social Media Logins

If you have already created local listings for your business at websites like Google Places, Bing Places, Yahoo Local or Yelp, please list them below so that we do not re-create them.

Google Places Username

Google Places Password

Bing Places Username

Bing Places Password

Additional Local Directory Listings

Comments/Questions