Captive Audience Review Station — Design Request Form

📍 Section 1: Business Information

Business Name (as it appears on Google) * Google Business Profile URL * Industry/Niche * Manager Email (for complaint routing - optional) Low ratings will be routed here privately instead of going to Google.

🚻 Section 2: Installation Location

Where will these be installed? * Number of Stalls per Washroom

🎨 Section 3: Design & CTA Preferences

Preferred Call-to-Action Style * Incentive-Based: "Win a $50 Tab — Tell us how we did!" Direct Ask: "Did our team earn 5 stars today?" VIP/Exclusive: "Join our VIP list for secret deals" Feedback-Focused: "Help us improve — scan to share" Custom Text (specify below)

Custom CTA Text (if selected above) Preferred Color Scheme Additional Text (tagline, phone, etc.)

⚙️ Section 4: Technical Setup

Enable Review Gating Filter? * ✅ Yes — Route low ratings (1-3 stars) to private email ❌ No — All ratings go directly to Google

Monthly Review Gap Report (First month free) ✅ Yes, email me monthly analytics ❌ No thanks

Best Email for Delivery Updates *

🔧 Section 5: Hardware Preferences

Frame Material (confirm your order)

Mounting Preference 🔲 3M VHB Tape (No-Drill Install) — Recommended 🔩 Screw-Mount — Send me the template

Estimated Design Proof: 48-72 hours

Questions? fulfillment@niagarastandsout.com

📋 Captive Audience Review Station

Custom Design Request Form

📍 Section 1: Business Information

🚻 Section 2: Installation Location

🎨 Section 3: Design & CTA Preferences

⚙️ Section 4: Technical Setup

🔧 Section 5: Hardware Preferences

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