Senior Care Authority Intake Form

About 10 minutes. Have your IRS CP 575 letter handy. You can save and finish later.

Bronze – $299/month. Includes one (1) territory. 12-month term, billed monthly.

Have more than one territory? Submit one form per territory. Each additional territory is +$100/month.

Main Point of Contact for Account

Who is the person that City Ranked will primarily work with in your organization?

How Can We Reach You?

We would love to chat with you. How can we get in touch?

Your Cell Phone(Required)

Territory Information

Next we will ask information about your specific territory.

Legal Business Name(Required)

Registered business name with the IRS

Territory Name(Required)

SCA of (name)

Advisor Website Link(Required)

Your homepage website link on www.seniorcareauthority.com

Vanity Website Link

Fill in if you have a branded website URL pointed to your SCA website.

Primary Business Phone(Required)

Your main business line.

Main SCA Email(Required)

What email do you use as your main email address. We will also use this email to send notifications.

Upload a copy of IRS form CP 575(Required)

Form CP 575 is the EIN confirmation letter the IRS sent when you registered your business.

Max. file size: 10 MB.

Business Hours(Required)

(e.g., Mon–Fri, 9am–5pm)

Franchisee Information

Franchise Owner Cell Phone(Required)

Upload a profile headshot

Square photo, at least 512×512 px.

Max. file size: 10 MB.

Hyperlocal – GPS SEO

Target Areas(Required)

Tell us the specific neighborhoods, cities, or ZIP codes you’d like to target for local SEO.

Areas to Exclude (if applicable)

Tell us which areas to exclude from your targeting ( neighborhoods, cities, or ZIP codes)

URL

This field is for validation purposes and should be left unchanged.

First Name(Required)

Business Name(Required)

First Name(Required)

Fill out the form below to get started on a local marketing package.

Local Optimization Packages

Basic Package Details+

Bronze Package Details+

SCA Franchisee Intake – Bronze

Main Point of Contact for Account

How Can We Reach You?

Territory Information

Franchisee Information

Hyperlocal – GPS SEO