Order Form Step 1 of 5 - Customer Information 20% Customer Status*New - 1st Purchase from BuzzazzExistingHow Customer Connected with Buzzazz*Internet Search ResultsReferralChamber of Commerce AffiliationCold Called by TelemarketingCold Called in PersonEmail SolicitationWaBammSaw Buzzazz OfficeOtherSales Representative* First Last Company Name*Customer Name* First Last Title*Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabweCountry Office Phone*Cell PhoneEmail* Enter Email Confirm Email Existing Website What is the business industry?*Accounting/FinanceAdvertising/Public RelationsAerospace/AviationArts/Entertainment/PublishingAutomotiveBanking/MortgageBusiness DevelopmentBusiness OpportunityClerical/AdministrativeConstruction/FacilitiesConsumer GoodsCustomer ServiceEducation/TrainingEnergy/UtilitiesEngineeringGovernment/MilitaryGreenHealthcareHospitality/TravelHuman ResourcesInstallation/MaintenanceInsuranceInternetJob Search AidsLaw Enforcement/SecurityLegalManagement/ExecutiveManufacturing/OperationsMarketingNon-Profit/VolunteerPharmaceutical/BiotechProfessional ServicesQA/Quality ControlReal EstateRestaurant/Food ServiceRetailSalesScience/ResearchSkilled LaborTechnologyTelecommunicationsTransportation/LogisticsOtherClients they service?*ConsumersBusinessesConsumers & BusinessesWhich marketing / advertising are they currently doing?* Online - Social, Email, SEO, Phone App, Etc. PPC - Google, Facebook, Etc. Print - Newspaper, Direct Mail, Etc. Multimedia - TV, Radio, Billboards Direct - Call Center, Sales Reps, Events, Etc. None Which do they want to start or do more of?* Online - Social, Email, SEO, Phone App, Etc. PPC - Google, Facebook, Etc. Print - Newspaper, Direct Mail, Etc. Multimedia - TV, Radio, Billboards Direct - Call Center, Sales Reps, Events, Etc. What is their current total marketing / advertising budget?*Business Purpose*Example: To help Clearwater citizens have healthy mouths.What is their unique selling proposition?*Example: Dentist dedicated to all natural technologies - No drugs.What is their average price per sale?*How many do they sell per week?*What is their current yearly gross revenue?*0 - 500K500K - 1 MIL1 - 10 MIL10 MIL +What is next years yearly gross revenue goal?*List their real competitors*Where would they like their company to be in 5 years?*Example: 200 Employees, 20 Mil, 5 State Offices, Retired, etc. Buzzazz Services*ServicePrice $Expected Date of Delivery Grand Total $*Today's Payment $*Monthly Payment $If neededDate of Automatic DebitTreasury Notes*What Problem(s) Will These Services Solve For The Client*Example: New responsive website to solve the problem of their current site not being mobile friendly.Product Result Expectations - From clients viewpoint*Be as specific as possible as to what the client has duplicated that this order will produce for their business.Final Vital Order Notes*ANYTHING & EVERYTHING we need to fully deliver this order.PLEASE UPLOAD THE SIGNED CONTRACT & ANY ADDITIONAL NOTES TO HIGHRISE. Does this order include a Digital Marketing Service?*YesNoDomain Registrar Access*Domain Registrar (where the domain name was purchased through Example: Godaddy.com, networksolutions.com, etc.) Username*Password*CMS Login*CMS (Content Management System) website such as wordpress we will need the administrator loginUsername*Password*Hosting Provider*Examples: Godaddy, Network Solutions, HostGator, etc.Username*Password*Client Agreed Upon Targeted Keyword Phrases & Organic Rank*Client Agreed upon keyword phrases to target and current organic rank. (Example: "clearwater auto repair" - Currently #25 Organic Rank) ONLY 1 Keyword Phrase Per every $100 spent.Other Login Data For Project*Example: social media, email marketing, etc. Payment Type*Automatic Check WithdrawalCredit CardAlready On FileCard Type*VISAMastercardDiscoverCard Number*Month*010203040506070809101112Expiration DateYear*201520162017201820192020202120222023202420252026Security Code*Cardholder Name*Bank Routing NumberBank Account NumberSummary of terms & conditionsDelivery SchedulesGuaranteed Delivery within 30 days of receiving full payment, content and access.Company FinancingIf approved for Buzzazz zero interest financing, client agrees to allow auto debits on specific dates to fullfill entire amount of obligation. Services may be delivered prior to or by end of full payment at discretion of Buzzazz.Service FeesTo help offset some of the expenses and ensure we can continue to provide excellent customer service, you agree to nominal monthly service fees (MSF) and annual registration fees (ARF) for some services listed above. The basic MSF/ARF fees start at $39.95 and $75 and can be higher.Change OrdersAlso, once a project final punch list is approved, other changes can be made. Change orders must be paid separately at $75 per hour or greater. Service TerminationAfter initial contract time frames have been fulfilled - unless written differently in a specific contract our normal term of service is for thirty six months - we require a minimum of 30 day written notification of termination. We will immediately initiate terminations upon written notification from the client and the client will be automatically billed and responsible to pay one further month of service fees.To view the full terms & conditions please CLICK HEREAuthorized Agreement* I affirm with my signature below that I am the person listed in this order and fully understand and agree to all payment obligations, order specifics, and Buzzazz terms of agreement as listed above. If signed by the Buzzazz sales representative below, the sales representative is attesting the client knows and understands Buzzazz terms for their project, or the client has signed a Buzzazz authorized hard copy order form which is or will be filed at Buzzazz.SignatureLet us know you are human This iframe contains the logic required to handle Ajax powered Gravity Forms.