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Reputation Videos Client Intake Form

Please fill out the following information about your Business or Organization, so we can get started on producing the video for you.

Your Name (required):

Your Email (required):

Your Phone #:

Subject Line (i.e. Intake from ... {your Business Name})

Business Name:

Business Phone #:

Business Address:

Business City, State, Zip:


Input a 5 Star Review To Promote in the Video (Copy and Paste the Text Review you have below):

Website URL:

Main Branding Color:

YouTube Login Email (If you don't have one, create a new Gmail account with your businessName@gmail.com address)

YouTube Gmail Login Password: (so we can syndicate video to your YT account)

Business Logo & Photo Of Your Office Or Lobby as Background of Video:

Please email your Logo and Office Photo as Attachments to: admin@apexprofitsolutions.com. Thanks!

Any extra Message:

We’ll send you a secure payment form online to fill out shortly upon receiving your Intake Form…