Name*

First Last

Company Name*

Website*

Email*

Phone

Address (Optional, but may help us analyze local info)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

What package are you interested in?*

Local Foundation
Marketing Strategy
Jumpstart
Catalyst
Marketing Department

Describe your business*

How much of an investment in marketing do you think it will take over the next 12 months to take your business to the next level? (this includes advertising, PR, consulting, direct mail, etc.)*

Under $15,000 (Great, lets talk about getting you started towards bigger things)
Between $15,000 - $50,000 (Awesome, let's talk about building a marketing system)
Over $50,000 (Very serious. Let's proceed with this process, but this level of investment calls for a more comprehensive discovery process as well)

Describe your ideal customer as thoroughly as possible*

Describe the core point of differentiation for your business vs. others in your same field*

Do you currently follow an editorial calender?*

Yes
No

If yes, please explain

What does your social media plan consist of?*

What local and industry related directories is your business listed on? (i.e. Yelp, SuperPages, etc.)*

Are you currently doing anything to stimulate reviews from your clients?*

Yes
No

If yes, please explain

What key business metrics are you tracking?*

From the below, select which best describes your understanding of the importance of the elements on this form*

Completely understand and just need help getting it done
Understand I need to be doing some of this stuff
Don't understand why I would need to be doing any of this

What is the #1 thing you would hope to gain from working with us?*

Do You Qualify?