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If you are experiencing hardships due to COVID-19, please email us at hello@360mediaco.com and let’s work together to make sure your website stays functioning.

Name of Business*
Email*
Date
Date Format: MM slash DD slash YYYY
Name on Card*
First Last
Address for Card*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
New Card Number*
Exp Date*
Security Code*
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I authorize 360 Media Co to charge the amount listed on in my contract to include both initial investment and monthly fees. All declined fees are my responsibility.*
Signature*

Client Info
Name*
First Last
Name of Business*
*If you are a multi-location, please include your location city.
Email*
Name of Page Needing Revisions or Added*
You can also copy/paste the URL of the page here!
What Are You Looking to Change?
In a few short words, please provide changes requested.*
If you need a third-party app attached, like Trello or Active Campaign, please make a note of that as well.
Do you need to attach any photos or files?
Drop files here or

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Please upload your files here and we will contact you if we have any questions about them.

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What Are You Looking to Change?