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Start > Social > Web > Newsletter >  Payment >  Misc
The Easy Stuff
Let's start off with what you (hopefully) know off the top of your head.
 Business Name * :
 Business Website :
 First Name * :
 Last Name * :
 Email * :
 Phone Number * :
Next >
SOCIAL MEDIA LOGINS
Please include information for all of your accounts.
If you have not yet created an account, please write "NO ACCOUNT"
If you've lost the login information for any accounts, please make all possible attempts to retrieve the data using the lost password options associated with the account. If you've exhausted all possible avenues and you still can't get in, please write "LOST LOGINS" - but please try every possible way to get in first.
 Facebook Login :
 Facebook Password :
 Twitter Login :
 Twitter Password :
 LinkedIn Login :
 LinkedIn Password :
 Gmail Address :
 Gmail Password :
 Instagram Login :
 Instagram Password :
 Pinterest Login :
 Pinterest Password :
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Website Information
Please provide whatever information you can. If it's easier for you, please feel free to introduce us directly to your webmaster and we can work out the details with them.
 Website Login url :
 Website Username :
 Website Password :
 Host Login url :
 Host Username :
 Host Password :
Google Analytics
Are you already set up with Google Analytics?
*Not sure if you have Google Analytics? Please connect us with your webmaster. And enter the email address associated with your Google Analytics & Password 
Yes 
No 
Not Sure 
 Login Email :
 Google Password :
Server Details
Don't worry if you don't have this information. This information is optional, but helpful. If you have a webmaster, please ask them for the information or connect us with them directly.
Server OS:
Server Software:
SFTP or FTP:
S/FTP Login url:
S/FTP Username:
S/FTP Password:
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Newsletter Platform
(if applicable)
Service (Mailchimp, iContact, etc.)
Platform:
Login:
Password:
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Credit Card and Payment Details
We appreciate your business! Full payment is automatically billed to the credit card on file on the first (1st) of each month.
Type of Card:VisaMasterCardAmerican ExpressDiscover
Name on the Card *:
Credit Card Number *:
Expiry Date *:
3 digit CVV2 code *:
Street Address *:
City *:
Province/State *:
Postal/Zip Code *:
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Questions or Comments
Anything we miss?
Message:


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