Reputation Engine Intake Form - Sterling Media House

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1. Legal Business Name

2. DBA (if different)

3. Primary Contact — Name

3. Primary Contact — Title

3. Primary Contact — Phone

3. Primary Contact — Email

4. Secondary Contact — Name

4. Secondary Contact — Phone

strategize value? handle

4. Secondary Contact — Email

5. Service Area

What cities, counties, or radius do you serve?

6. Years in Business

7. License / Insurance Numbers (if applicable — roofing, electrical, HVAC, etc.)

8. Current Website URL (if any)

9. Do you have an existing logo and brand colors?