Intake Form

Project Intake Form

Please provide the following information to help us understand your needs for your website and targeted display campaign.

Website Needs

Do you currently own a domain name and have access to its settings?

Yes No (Additional cost may apply)

If you don’t own a domain, we can help you acquire one.

Your Logo (if available)

Please email your logo to digital@regionalmediainc.com with your business name as the subject line.

Do you have photos you’d like to use on your website? If so, please describe them.

Please email your photos to digital@regionalmediainc.com with your business name as the subject line.

Please provide your professional bio or a description of your company.

List the services you offer.

Separate each service with a new line or a comma.

Contact Information to display on the website (e.g., Phone, Email, Address, Social Media Links)

Are there any specific legal requirements, disclosures, or privacy policies needed for your website?

If you have existing documents, please indicate.

Specify targeted locations (ZIP, city, county, or state).

You can also list areas to exclude. (Additional cost for market research if targets are unknown)

Do you have existing ad creatives, or would you like us to create them?

I have existing creatives Please create them for me (First round included, subsequent rounds additional charge)

Please email your ad creative files (images/videos) to digital@regionalmediainc.com with your business name as the subject line.

Landing Page URL for the campaign

This is where users will be directed after clicking your ad.

Your Logo for the Display Campaign (if different from website logo)

Please email your campaign logo to digital@regionalmediainc.com with your business name as the subject line.

Describe any pertinent imagery for your campaign ads.

Please email your campaign imagery to digital@regionalmediainc.com with your business name as the subject line.

Preferred Call-To-Action (CTA) or key verbiage for your ads.

What action do you want users to take?