Name *
E-mail Address *
Title *
Company Name *
Address
Address #2
City, State, Zip
Phone Number *
Fax Number *
Web-Site Address
# Of Employees
Biggest Competitor
Company Description (Industry)
Annual Company Revenue's
Less than $100,000
$100,000 - $250,000
$250,000 - $500,000
$500,000 - $1,000,000
$1,000,000 - $2,000,000
$2,000,000 - $5,000,000
$5,000,000 - $7,500,000
$7,500,000 - $10,000,000
Over $10,000,000
How should we contact you
Phone
E-mail
When is the best time to contact you
8:00am - 12:00pm
12:00pm - 5:00pm
Evenings (at home)
My marketing and advertising is *
Not happening at all
An inside company function
Outsourced to an advertising agency
I don't know
My immediate need is *
Growing sales revenues
Increasing gross profit margins
Creating a solid sales system
Increasing customer service
Introducing new products / services
All of the above
I presently use the following items (check all that apply) *
If I had the opportunity I would like to use (Check all that apply)
I'm interested in the following KMG resources (Check all that apply)
General Comments
Are you the decision maker regarding company marketing efforts
Yes
No
Committee
Outsourced
