REPUTATION MANAGEMENT APPLICATION ONLINE REPUTATION MANAGEMENT APPLICATION Fill out this form if you are losing money to other businesses due to your poor online reputation. We can help. Step 1 of 2 50% BUSINESS NAME*WEB ADDRESS*CONTACT NAME*CONTACT EMAIL* CONTACT PHONE NUMBER*Are You Able to Make This Decision For the Company on Your Own?* Yes No Not Sure Are you the person in charge of payment for this type of services to said company? Tell us About Yourself and the Online Reputation Problems You Are Experiencing.*Is There ANY Truth to the Allegations Made? (It is ok if this answer is yes) but we need to understand why you are being bashed.*How Much Money do You Think You lose Per Month Because of Your Poor Reputation?* Under $1,000 Over $1,000 but Under $10,000 $10,000 or More Are you losing traffic and sales due to your reputation? How much do you anticipate you lose every month?