MVP Intake Test

Provider intake form

This form creates a business record, contact record, intake record, service records, and service-area records in Supabase. Stripe and AI generation will connect next.

1. Package

Selected package

2. Business identity

Business name

Website or social link

Contact person

Contact role

Contact email

Contact phone

Existing business description

3. Category and location

Primary category

Base city

Service areas, comma separated

Service radius

Regulated or licensed business?

Licence/certification note, optional

4. Services

Add one service per line. Use 3 services for the $199 setup and 5 for the $499 setup.

5. Lead handling

Public phone

Public email

Business hours

Preferred customer CTA

Emergency or after-hours service available

6. Google and consent

Google Business Profile status

I confirm I am authorized to submit this business information.I understand LocalOffer AI may use AI to improve and structure this page.I understand LocalOffer AI does not guarantee leads, sales, or Google rankings.I understand the business is responsible for its own services, claims, pricing, licences, insurance, warranties, and fulfillment.I agree to be contacted about this profile/order.