Thank you – Please Submit Your Information Now.

Submit Your Information for the Authority Authorship and Backlinking Program

NOTE: You must fill out this entire form all at once. You can't "save" a portion of it and come back later.

Don't have time rigt now? That's ok, just come back to http://www.ltcsocialmark.com/authority-site-form/ later and complete it at your convenience.

Please fill out this form completely. Please be sure to upload a logo and a photo of the owners or marketers of the business at the end of the form.

• Contact Person's Name:*

  FirstLast

  Please enter the name of the person we will be communicating with about this project.

• Contact Phone:*

  (###) ###-#### , Please enter the phone number of the person we will be communicating with about this project.

• Contact Email Address:*

  Enter the email address of the person we will be communicating with about this project.

• What is the name of the person who should be featured on the profile pages?*

  If this is not you (the person filling out the form/contact), then please enter the name of the person who should be highlighted as the expert author etc. This might be an owner or other employee. If it's YOU, just put your name in the box.

• Business Name:*

  Enter Your Business Name as you Would Like it to Appear on HelpforAgingVeterans.com

• Type of Business:*

  Please Indicate if Your Business is a Private Duty Home Care Agency, Home Health Care Agency, Assisted Living, etc.

• Website*

  Please enter your website address.

• Business Address*

  Street AddressAddress Line 2CityStateZIP Code

  Enter Your Business Address as you Would Like it to Appear on HelpforAgingVeterans.com

• Business Phone:*

  (###)###-#### , Enter the Phone Number of the Business.

• Email Address of Business:*

  Enter the email address where you would like to have leads sent to. Please enter ONE email address at this time.

• Your Service Area:*

  Please give us a list of the top 10 towns/counties that your business serves. This should be the service area from the address you entered above. If you have more than one location, please fill out a form for each location that will be listed in our database.

• Short Description of Your Business (Tag Line)*

  Please enter a very short description of your business. This is limited to 200 characters.

• Give Us a Longer Description About Your Business: (About Us Page Style)*

  Enter a longer description about your business. This should be similar to an About Us page. This is limited to 2000 characters.

• Upload Your Logo Here.

  Your logo should be uploaded here. Make sure the size is a min of 250x250.

• Upload Your Professional Photo Here.

  Your professional photo (photo of owners or marketer etc) should be uploaded here. Min. size should be 250x250.