New client Form

Point of contact details

First Name


Date of Birth

Mobile phone no. for personal contact only

Details of Gmail Account and Google Access

Do you have Gmail Account?

If yes, please enter your mail here

What is your password for this account?

Are you listed in Google maps currently?

If yes, please enter your Gmap Id here

What is your password for this account?


Year Established

Company Name

Street Address

City Town


Post Code / Zip code


Company Phone

Company Fax

Alternate Phone

Company Website

Do you have any other website

If yes, Please list your websites

Do you have any unused domain

If yes, Please list below

Business Email for your clients

Enter any additional Phone no.

Business Description

Please could you briefly describe your business in approximately 200 characters?

Please provide a longer description of your business, in approximately 800 words, which should not contain the following:

  • Your website or email address.
  • Please ensure that this description is written in the third person (i.e.) must not contain the words"We, Our, You, I, Us, My, I've or I'm".

Mobile Alerts

Do you want to receive a free text message if you get an enquiry regarding your business?

Please enter your mobile no. here

Business Categories

What are the 5 best words that sum up what your business does?

Target Market

What are the 5 main target markets for your business or service?


Does your business have a fixed location?

Do you go out to meet your customers?

Are all your customers local to you?

Business Opening Hours








Customer payment options available

Tick required

Upload your business photos
To promote your business, please provide some photographs of the business or service you provide. These should be of the following size: 1 MB with .jpg / .gif / .png.

Please Note :
By providing Blend Local Search Marketing with these photos, you are delighted for us to help you get more customers and accept that you own the copyright of these images and take all responsibility of the listing. Please ensure that one of the images is your business logo.

Promotional Media

Provide a logo jpeg or photo of your business location.
Do you have any videos promoting your business? (If you have a youtube channel please provide the link here or a way to access the videos.)

Please provide the link to your youtube channel or insert the video urls here

What are the urls for your videos?

Are there any other facilities, services or benefits that you offer that you haven't mentioned?

Please select one

If yes, please describe more about your business here.


Please select your company