Form Test - Rooah! Web and Digital Solutions

Full Name *

First

Last

Personal Number *

What phone number(s) should we contact you on?

Personal Email *

Personal Facebook ID

(e.g. facebook.com/irooah or @irooah)

Secondary Phone Number *

Who do we reach if we can't reach you?

Secondary Email *

Business Name *

Enter the name of your company or your website domain address (eg. www.rooah.com)

Business Phone *

What phone number(s) should we list on your website?

Business Email *

What email address would you like your business messages sent to?

Tell us about your company in your own words. *

Please include these details: Why did you start this business? What services/products do you offer? What's special about your business location? Business hours

Business Full Address *

Where is your business located?

Hide Address

Do You Have a Domain Name? *

Who Is Your Domain Registrar? *

Enter Domain Name *

e.g. www.mybusiness.com

Desired domain name (if you don't have one) *

e.g. www.mybusiness.com

Can we purchase a close alternative domain if your desired one is unavailable? *

Social Media Links

Please list all your social media account links here. We will add shortcuts to them on your website/app.

Any company sponsors or certifications?

If Yes, please list all company sponsors and certifications. (Optional)

Do you have a logo? *

If yes, please upload it (.PNG format ONLY) *

Click or drag files to this area to upload. You can upload up to 2 files.

File size upload limit is 10MB

If not, would you like us to design one for you for $150? *

What year did your business start? *

Accepted Payment Methods

Anything else you'd like to add?

Website Demo Selection

(Click on design demo image to select. Click on demo title to preview design)

Select a Design (Click on design demo image to select) *

Demo 1
Demo 2
Demo 3
Demo 4
Demo 5

Who referred you to us? *

Because we’d like to send them a thank you!

Terms & Agreements *

By checking this box, I agree to the Rooah! service level agreement, terms and privacy policy.

Please review and agree to the above service level agreement, terms, and privacy policy before proceeding.