Name: (*)

Email: (*)

Phone Number: (*)

Cell / Alternate Number:

URL (if applicable):

How can I help you? Please check the appropriate box(es):

 Marketing

 Copywriting

 Both

Please complete the following questions if you need marketing services:

Name of Business:

Years in Business:

 Less than 1 year   1 - 4 years   5 - 10 years   10 or more years   Startup 

Annual Revenues:

 Less than $100,000   $101,000 - $499,000   $500,000 - $1,000,000   $1,000,000 - $5,000,000   $5,000,000 and up   No revenues - startup phase 

I'm currently struggling with (check all that apply):

Flat or declining sales

Increased competition

Missed opportunities

Ineffective marketing campaigns

Select the statement which most closely matches your current state of business:

Sales are worse this year compared to last year

Sales are about the same this year compared to last year

Sales are better than last year, and we want more

Tell me about your business (what you sell, what challenges you're facing, etc.:

Please complete the following questions for copywriting projects:

Copy Type:
 Select copy type   sales letter   web copy   email copy   search engine copy   product/catalog copy   space ads   lead generation   fundraising letter  other

Time Frame:
 Select time frame   1 -2 weeks   this month   no rush   I'm in a hurry 

Budget:
 Select budget   <$1000   $2000   $5000   unlimited 

Style of writing preferred:
 Select desired writing style   corporate   conversational   technical   fun   no idea / need advice 

Comments / Questions / Special Requests:

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