Customer Input Form

Introductory Marketing Consultation
Simply complete the form below and submit payment (on the next page). We'll schedule a time for us to meet, either in person or by phone, for the consultation.

First Name*

Last Name*

Email Address*

Company Name*

Title*

What does your company do?*


Have you ever worked with a marketing consultant or coach?*
Yes No

What is your experience and/or thoughts about working with a marketing advisor?*


What are you looking for from a marketing system?*


In what areas do you believe that your business would improve if you worked with me?*


What are three top marketing issues challenging you right now?*


Do you currently use relationship marketing (sending birthday cards, thank you cards, etc) as part of your business strategy?*
Yes, I have a great system and I'm able to stay on top of it Yes, but I need to do better No, but I know that I need to No, I don't think it's important

How do you keep track of your contacts?*
Sales Software, such a ACT! Outlook Internal system from your company Online system Excel spreadsheet Other

Do you send out email updates, newsletters and/or announcements to your contacts?*
Yes No

What are your thoughts about sending email announcements, updates & newsletters to your contacts?*


Does your competition send out email newsletters, updates or announcements? *
Yes No I don't know

Have you ever used, or do you currently use, a do-it-yourself email newsletter system?*
Yes No

If you've used an email newsletter system before, what did you like best and what did you like least about it?


Would you send more postcards, flyers and print mail to your contacts if you had an easy way to do it?*
Yes No

Phone Number*

Mobile

Fax

Address*

Address 2

Address 3

City*

State*

Zip Code*

Website

Comments:


You will be taken to the next steps after payment is completed. Click submit to send us your survey and proceed to the payment screen.

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