Temp – New HVAC Client Form This field is hidden when viewing the form Program Name Primary Contact Information Name(Required) First Last Phone(Required) Email(Required) Alternate Contact Information Would You Like To Add An Alternate Contact?(Required) Yes No Alternate Contact Name(Required) First Last Phone(Required) Email(Required) Billing Contact Information Would You Like To Add A Separate Billing Contact?(Required) Yes No, use the primary contact for billing inquiries Would You Like To Add A Separate Billing Contact?(Required) Yes No, use the primary contact for billing inquiries No, use the alternate contact for billing inquiries Billing Contact Name(Required) First Last Phone(Required) Email(Required) Company Information Company Name(Required) Are You Required To Display License Numbers On Your Website?(Required) Yes No Please Include License Number(s) And Description(s)(Required) Do You Have A Maintenance Agreement?(Required) Yes No Upload Your Company's Maintenance Agreement Drop files here or Select files Max. file size: 10 MB. Current Website Do You Have A Website?(Required) Yes No Current Website URL(Required) Website Phone Number(Required) Is This A Tracking Phone Number?(Required) Select one...YesNoUncertain Do You Own The Content On Your Current Website?(Required) If your content was created by your company we can use it on the new website. Yes No Domain Registrar Do You Know Where Your Domain Is Registered?(Required) For example, registrars include GoDaddy and Network Solutions. Yes No Your Domain Registrar(Required) Do You Have The Registrar Login Information?(Required) Do not include your login information on this form. We will collect this information at a later time. Your web coach will discuss this with you. Yes No Email Information Do You Have Emails Set Up With Your Domain?(Required) For example, jane@yourcompanyname.com. Yes No Who Is Your Email Provider?(Required) Forms Forms offer a way for visitors to contact your company. Let us know which forms you would like included on your site. Include The Following Forms On The Website(Required) Contact Form Employment Form Request Estimate Form Request Service Form Include The Following Forms On The Website(Required) Contact Form Employment Form Request Estimate Form Request Service Form BxB Review Form Pay Online Form Include The Following Forms On The Website(Required) Contact Form Employment Form Request Estimate Form Request Service Form BxB Review Form Pay Online Form Charitable Giving Voting Form (does not send notification emails) Customer Referral Form Would You Like Submissions From All Forms Sent To The Same Or Different Email Address(es)?(Required) Send submissions to the same email address(es) Send submissions to different email address(es) per form Form Notifications(Required) Include the email address(es) you would like form submissions sent to. If more than one address, separate them with commas. Contact Form Notifications(Required) Include the email address(es) you would like form submissions sent to. If more than one address, separate them with commas. Contact Form Notifications(Required) Include the email address(es) you would like form submissions sent to. If more than one address, separate them with commas. Contact Form Notifications(Required) Include the email address(es) you would like form submissions sent to. If more than one address, separate them with commas. Employment Form Notifications(Required) Include the email address(es) you would like form submissions sent to. If more than one address, separate them with commas. Employment Form Notifications(Required) Include the email address(es) you would like form submissions sent to. If more than one address, separate them with commas. Employment Form Notifications(Required) Include the email address(es) you would like form submissions sent to. If more than one address, separate them with commas. Request Estimate Form Notifications(Required) Include the email address(es) you would like form submissions sent to. If more than one address, separate them with commas. Request Estimate Form Notifications(Required) Include the email address(es) you would like form submissions sent to. If more than one address, separate them with commas. Request Estimate Form Notifications(Required) Include the email address(es) you would like form submissions sent to. If more than one address, separate them with commas. Request Service Form Notifications(Required) Include the email address(es) you would like form submissions sent to. If more than one address, separate them with commas. Request Service Form Notifications(Required) Include the email address(es) you would like form submissions sent to. If more than one address, separate them with commas. Request Service Form Notifications(Required) Include the email address(es) you would like form submissions sent to. If more than one address, separate them with commas. BxB Review Form Notifications(Required) Include the email address(es) you would like form submissions sent to. If more than one address, separate them with commas. BxB Review Form Notifications(Required) Include the email address(es) you would like form submissions sent to. If more than one address, separate them with commas. Pay Online Form Notifications(Required) Include the email address(es) you would like form submissions sent to. If more than one address, separate them with commas. Pay Online Form Notifications(Required) Include the email address(es) you would like form submissions sent to. If more than one address, separate them with commas. Customer Referral Form Notifications(Required) Include the email address(es) you would like form submissions sent to. If more than one address, separate them with commas. Social Media Which Social Media And Directories Are You Currently Using?(Required) Angi Facebook HomeAdvisor Houzz Instagram LinkedIn Nextdoor Pinterest Twitter Yelp Other None Angi URL(Required) Facebook URL(Required) HomeAdvisor URL(Required) Houzz URL(Required) Instagram URL(Required) LinkedIn URL(Required) Nextdoor URL(Required) Pinterest URL(Required) Twitter URL(Required) Yelp URL(Required) Other Social Media(Required) Please include the social media URL(s) below. Google My Business Is Your Business Verified With Google My Business?(Required) Yes No Do You Have Your Login And Password For Google My Business?(Required) Do not include your login information on this form. We will collect this information at a later time. Yes No Google Paid Advertising Are You Currently Using Paid Google Advertising Such As Google Local Service Or Pay Per Click?(Required) Yes No Who Is Currently Managing Your Account?(Required) We manage our own account We pay someone to manage our account for us Business Services Please indicate which services you provide and would like to include on your website. Do You Provide Residential Services?(Required) Yes No Which Residential Services Would You Like Included On The Website?(Required) Air Conditioning Air Ducts and Air Duct Cleaning Air Ducts but not Air Duct Cleaning Air Handlers Boilers Ductless Systems Electrical Gas Fireplaces Gas Furnaces Geothermal Heat Pumps Heat Pumps Home Automation Indoor Air Quality Oil Furnaces Plumbing, minor (water heaters, water softeners, sump pumps, etc.) Plumbing, major (most or all plumbing services) Radiant Floors Sheet Metal Whole-House Generators Zone Control Other List Additional Residential Services(Required) Do You Provide Commercial Services?(Required) Yes No Which Commercial Services Would You Like Included On The Website?(Required) Cooling Heating Electrical Plumbing Refrigeration Other List Additional Commercial Services(Required) E-Commerce Do You Offer Products Or Services For Sale On Your Current Website(Required) Yes No Please Provide A General Explanantion Of What You Offer(Required) Products And Services Do You Offer 24/7 Emergency Services?(Required) Yes No What Is Your Primary HVAC Brand?(Required) Amana American Standard Bryant Carrier Champion Coleman Comfortmaker Daikin Day & Night Goodman Lennox Luxaire Mitsubishi Rheem Ruud Trane York White Label (Own Brand) Other Enter Primary HVAC Brand(Required) Are you a Customer Care Dealer?(Required) Yes No Are you a Factory Authorized Dealer (FAD)?(Required) Yes No Are you a Certified Comfort Expert (CCE) Contractor?(Required) Yes No Are you a Comfort Pro Contractor?(Required) Yes No Are you a Lennox Premier Dealer?(Required) Yes No Are you a Mitsubishi Diamond Contractor?(Required) Yes No Are you a Pro Partner Dealer?(Required) Yes No Are you a Trane Comfort Specialist (TCS) Contractor?(Required) Yes No Who Is Your Distributor?(Required) Distributor Website Service Area Top 3 Service Cities(Required) Start by listing the top three cities you serve, in order of importance to your business. If you are listing cities from multiple states, please include the state abbreviations. Click the '+' icon to add a new city. Add Remove Additional Service Cities List up to 7 additional cities. If you are listing cities from multiple states, please include the state abbreviations. Click the '+' icon to add a new city. Add Remove Additional Service Cities List up to 12 additional cities. If you are listing cities from multiple states, please include the state abbreviations. Click the '+' icon to add a new city. Add Remove Financing Do You Offer Financing?(Required) Yes No Who Do You Use For Financing?(Required) Branding Information Are You Able To Upload Your Company's Logo in a vector format if possible (.ai, .eps, .svg)?(Required) If you are unfamiliar with this file type, you can contact your local printer or company that has done your truck wrap designs. Yes No Upload Company Logo(Required) Preferred file formats: AI, SVG, and vector PDF. Drop files here or Select files Accepted file types: ai, eps, svg, jpg, jpeg, pdf, png, Max. file size: 50 MB. Does Your Company Have A Style Guide?(Required) Yes No Upload Company Style Guide(Required) Drop files here or Select files Accepted file types: pdf, Max. file size: 128 MB. Does Your Company Use Pantone Colors?(Required) Yes No List Pantone Colors(Required) Additional Information Are You Planning To Use Co-Op Dollars For BxB Media Services?(Required) Yes No In Addition To Your Website, What Are Your Top 3 Marketing Priorities? Branding or rebranding Paid digital advertising (Google Local Service advertising, Google Pay Per Click, etc.) Other advertising (radio, billboards, vehicle wraps, etc.) Print collateral Email marketing Google My Business assistance Customer reviews strategy Other Other Marketing Priorities
