Website Intake Form – Circuit Bloom Media

Business Name *

Primary Contact Name *

Email Address *

Phone Number *

Business Location (City, Province/Country) *

Website (if existing)

What does your business do? *

Who is your target audience? *

What problem does your business solve?

What are the primary goals for your website? *

Generate leads Sell products Book appointments Showcase services Build credibility Provide information

Other Goal

What actions should visitors take on your website?

What does success look like for this website? *

Share at least one website you find visually appealing. This does not need to be in your industry. We just want to understand your taste.

Website URL *

What appeals to you about this site? *

Website URL

What appeals to you about this site?

Do you have professional photos for your website? *

Yes No Some

Do you need help with any of the following?

Copywriting Branding Logo design Photography Video production None needed

Additional Content Details

Competitor 1 (Name or URL)

Competitor 2 (Name or URL)

What do you like or dislike about these competitors' websites?

When do you need your website completed? *

As soon as possible Within 30 days Within 60 days Within 90 days No fixed deadline

Is there anything else you would like us to know?