Brief Customer Survey
Please fill in this survey as completely as possible. Doing so will allow us to better determine which services you qualify for and accelerate the delivery of savings.
Your Contact Information
Full Name
*
First Name
Last Name
Job Title/Position
*
Your Company Name
*
Company Zip Code (5 digit)
*
E-mail
*
Website
Phone Number
-
Area Code
Phone Number
Your Business Profile
Industry Type
Please Select
Auto Dealership
Manufacturing
Hotel/Resort/Restaurant
Bank
Administrative Services
Distributor
Retail
Other
Annual Revenue
Please Select
Under $1M
$1M-2M
$2M-5M
$5M-10M
$10M-20M
$20M-100M
$100M-500M
$500M-1B
Over $1B
Number of Employees
Please Select
Under 50
50-100
100-200
200-500
500-2000
Over 2000
Company Type
Please Select
S Corp
C Corp
LLC
LLP
Other
State Of Incorporation
Please Select
California
Alabama
Alaska
Arizona
Arkansas
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Not Applicable
Does the Company Own Commercial Property?
Yes
How Many Commercial Properties?
Please Select
1
2
3
5-10
11-20
21-50
51-100
Over 100
What is The Size of the Largest Property (sq.ft)?
Please Select
Under 10,000
10,000-50,000
50,000-100,000
100,000-500,000
Over 500,000
Does Your Company Pay Any of the Following Taxes (check all that apply)?
Federal
State
Local
Have You Deployed Any Energy Savings Initiatives?
Yes
What is Your Monthly Energy Bill (Electric + Gas)
Please Select
Under $1000
$1001-2000
$2001-5000
$5001-10,000
$10,001-25,000
$25,000-100,000
Over $100,000
Do you Recycle?
Yes
How Much Is Your Monthly Waste Disposal Bill?
Please Select
under $500
$501-1000
$1001-2000
$2001-5000
$5001-10,000
$10,001-25,000
over $25,000
Annual Credit Card Transactions (money taken from clients)
Please Select
Under $500,000
$500,001 - $750,000
$750,001 - $1000,000
Over $1000,000
Average Credit Card Transaction Size (money taken from clients)
Please Select
Under $25
$25 - $49
$50 - $74
$75 - $99
$100 - $149
Over $150
Which of the Following Are You Most Interested In?
Please Select
Nothing Specific
Accelerated Property Depreciation Deductions
Saving on Energy Bills
Hiring Tax Credits
Manufacturing Incentives (R and D)
Property Tax Review
Credit Card Interchange Fees Audit
Waste Disposal and Recycling Audit
Workers Compensation Insurance Audit
Freight/Parcel Audit
Other
How Quickly Would You Like To Start Recovering Expenses, Maximizing Government Benefits & Saving Money?
Please Select
Immediately
1 -2 Weeks
2 - 4 Weeks
1 Month or more
Comments
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