Main Point Of Contact
This is the person that will be contacted regarding the account. If this is the business owner please make sure to include the quickest form of communication (personal cell phone, email)
First Name
*
Last Name
Phone
*
Email
*
Business Details
Business Owner's Name
*
Legal Business Name
*
Address
*
City
*
State
*
Postal code
*
Business Phone
*
Business Email
*
Website
*
Facebook Page URL
Instagram Page URL
YouTube URL
Business Description
*
Services
*
Year Established
*
Number of Employees
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Hours of Operation
*
ROC# / LIC# (If Applicable)
Brands you carry
Certifications
Awards
Primary Markets
*
Special Offers/Promotions
Primary Competitors ( Top 2-3)
*
Business Branding
Brand Colors
Business Logo
Email
Email provider
What Email(s) Receive Your Website Forms
CRM
Current CRM (If Applicable)
Customer List
If you have a customer list please upload it here
Upload csv
Further Details
What are some of your goals in the next 3-6 months
*
What is your greatest current challenge in business
*
What Makes You Different Than Your Competitors
*
5 Words that describe your business/brand
*
Lead Follow Up Process
*
Any No No's we Should Know About?
*
Additional Notes
SUBMIT