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What is the customer's status?
*
Current OPTIMA customer adding Social
Current OPTIMA customer, upgrading to next program level and adding Social
Current OPTIMA customer, renewing program and adding +Social
Current OPTIMA Customer, Renewing +Social
Not an active OPTIMA customer
What program(s) is the customer purchasing?
+Social Only Packages
+Social AND Posting Packages
Posting Package Only
NEW OPTIMA +Social Program
OPTIMA +Social Program
*
Baseline +Social
Comprehensive +Social
Premium +Social
Did they purchase an additional Posting Package?
*
Yes
No
Posting Package Purchased
*
12 Posts
25 Posts
50 Posts
100 Posts
+Social added during Renewal window
*
Yes
No
Customer #
*
Business Name
*
Business Owner's Name
*
Claimed Business Address
*
Address Line 1
Address Line 2
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Private Email Address
*
Private Mobile #
*
OPTIMA Data Collection
Main Business Category
*
Products
Services
Brands
Specialities
Year Established
Slogan
Payments You Accept
*
Visa
Visa
MasterCard
Amex
Discover
PayPal
Personal Checks
Debit Cards
Cash
Apple Pay
Android Pay
Certifications
Associations
Location Facts
Languages
5 Most Important Search Terms
Areas You Serve
Monday Hours
Tuesday Hours
Wednesday Hours
Thursday Hours
Friday Hours
Saturday Hours
Sunday Hours
Select Your Sites
*
Google
Google
Yelp
Bing
Apple Maps
Facebook
Manta
Hot Frog
Yahoo!
Angie's List
TripAdvisor
MapQuest
YP
Merchant Circle
Foursquare
Zomato
City Squares
Chamber of Commerce.com
OPTIMA Program Amount
*
+Social Program Amount
*
Posting Program Amount
*
Total Sale Amount
*
POS Amount
Facebook Questions
Do you have an existing Facebook Business Page
*
Yes
No
Do you or someone on your team have access to this page?
*
Yes
No
What to use for 1st Post Idea?
*
Business Description
Create Post
1st Post Idea to Create
*
Call to Action Button
*
Call Now
Send Email
Learn More
Additional Notes
Appointment Time for Social Specialist to Call
*
Best Contact Name and Phone #
*
Sales Rep Name
*
Website
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