1. Customer ID Number:  

2. Company Name:  

3. Contact Person:  

4. Street Address:   

5. City:   6. State:   7. Zip:  

8. Phone:   9. Fax:  

10. Email Address:  

11. Web Site Address:  

12. What is the nature of your business, products and/or services? Describe what you do.


13. What area of business would you like to improve?


14. Do you have specific types of products and/or services you would like to promote?


15. Who is your typical customer (currently)?


16. What customer would you like to attract?


17. Where do your customers most frequently come from (geographically)?


18. What geographical areas would you like to reach that you currently are unable to?


19. Keeping in mind what you have indicated above, what words, sentences or phrases would you use in a search engine to locate your business, product and/ or service? Please list as many as possible. (i.e. Portland Maine Injury Attorney or Flowers Delivery Orlando Florida, etc.)



Who is your current web designer and/or hosting company?


20. Contact Person:

21. Contact Phone:

22. Contact Email Address:
23 . Name of account executive:

24. Additional comments or requests: