Company Name: Contact Name:

Address: City: Zip:

State: Phone#1: Phone#2:

Web Address: Email:

How did you hear about us?

Do you currently employ a Marketing or Advertising Firm? Yes No

If yes, what is the name of the firm?

Do you currently have a budget for marketing and advertising? Yes No

What is your annual advertising budget, approximately? Select One $3000-$7000 $7000-$10000 $10000-$20000 $20000-$50000 $100000+

How many employees do you currently have? Select One 1-5 5-20 20-50 50-100 100+

Do you currently have a website? Yes No

If no, would you be interested in having our professional web department build one for you? Yes No

In the space below please list the ways that you have advertised in the past:

Of these methods, which in your estimation worked the best?

Do you have a company logo? Yes No

If no, would you be interested in one of our professionals designing one for you? Yes No

When would you like One Stop Media to begin our services? Select One ASAP 3-4weeks 2-4months 6months+ Not sure

Any additional comments: