Online Listing Management Info Form Step 1 of 4 25% LinkedInThis field is for validation purposes and should be left unchanged.Vivid Image Account Director* Cegi Wassman Heidi Arndt Kori Sanders Kristal Ehrke Other Contact InformationCompany Name*Primary Contact* First Name Last Name Business Email* This is the general email address you would like listed in your online directories for customers to contact.Your Email* Website URL*Business Phone*What is the primary phone number of the business?Toll-Free PhoneMobile PhoneAn optional mobile phone number that can receive texts from your Google Business Profile listing. Listing InformationHow would you like your business name listed?*How would you like your business address listed? Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country This must be a physical address, not a PO Box.What year was your business established? Hours of OperationSunday*Monday*Tuesday*Wednesday*Thursday*Friday*Saturday*What holidays is your office/business closed? Business category (i.e. Bakery, Painter... the more specific the better)*Are you a healthcare organization/facility?* Yes No What is your National Provider Identifier (NPI)?*Are you accepting new patients? Yes No What insurances do you accept?Are there specific procedures performed at your facility you would like mentioned?What healthcare related associations does your facility belong to?Are there specific conditions treated at your facility you would like mentioned?Are there any associations and/or memberships that should be listed?*What languages are spoken at your business/organization?*Is there anything specific you'd like to say about your business?*This will be included in the "From business name" section on your Google Business Profile & Apple Business Connect (a business overview). If you don't have specific content in mind, we will create a message for you.Do customers come to your location or do you have a service area?* Our customers come to us We have a defined service area If you have a specific service area what is it?Where can I park when I come to your business?Is your business wheelchair accessible?* Yes No Do you have a wheelchair accessible entrance? Yes No Do you have a wheelchair accessible parking lot? Yes No Do you have a wheelchair accessible restroom? Yes No Do you have wheelchair accessible seating? Yes No What payment types to you accept?* Cash Check Invoice All major credit cards Visa Mastercard Discover American Express Other What other payment types do you accept?Do we have your logo on file at Vivid Image?* Yes No Please upload logo hereMax. file size: 50 MB. Hi-res vector file preferredDo you have specific images you'd like used for your listing? If yes, please upload.* Yes No Maximum of 6 imagesImage #1Max. file size: 50 MB. Hi-resolution file preferredImage #2Max. file size: 50 MB. Hi-resolution file preferredImage #3Max. file size: 50 MB. Hi-resolution file preferredImage #4Max. file size: 50 MB. Hi-resolution file preferredImage #5Max. file size: 50 MB. Hi-resolution file preferredImage #6Max. file size: 50 MB. Hi-resolution file preferredDo you currently have a Google Business Profile account setup for your business/organization?* Yes No Would you like our help setting up a new account or accessing an account you don't have access to?* Yes No thank you If you need of our help with set up or claiming, your Account Director will reach out with more information on the costs involved. Do you have ownership of your Google Business Profile?* Yes No What email address has ownership access to GBP profile?*If you don't have this available, we can work with you to gain access to the account at an additional charge.Do you currently have a X (previously Twitter) account setup for your business/organization?* Yes No Please provide your X handle*Example "@amazon" If you don't have this available, we can work with you to gain access to the account at an additional charge.Do you currently have a Facebook page setup for your business/organization?* Yes No In order to connect your Vivid.Listings account to Facebook, we will work with you to grant admin access to our team at VI.Please provide the URL*Example: https://www.facebook.com/vividimageinc/. If you don't have this available, we can work with you to gain access to the account at an additional charge.What email address has access to the business Facebook page?*If you don't know who has access, we can work with you to gain access at an additional charge.Do you currently have a Instagram account setup for your business/organization?* Yes No Please provide the Instagram handle*If you don't have this available, we can work with you to gain access to the account at an additional charge.Data Consent* I consent to my submitted data being collected and stored Δ