Web Series Interview Form
Please complete this form below in order to secure your interview with "CBWR GROUP" Thank you!
Name
*
First Name
Last Name
Phone
*
Email
*
example@example.com
Please upload your headshot. This will be used for promotion of your episode. (500 X 500 PX)
*
Browse Files
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Choose a file
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of
Please upload your logo(500 X 500 PX)
*
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Business Name
Industry
Desserts, treats, snacks, other food
Luxury product or service
Liquor & Spirits
Other (for future series)
Are you a black-owned business?
Black-owned
Co-owned but I own 51% or more
Twitter Link:
Facebook Link:
Website Link:
Instagram Link:
Link to book you've written:
Where is the number one place you'd like me to direct the viewers? (ie. Website/Instagram/Facebook)
*
What are some questions you'd like me to ask you during the interview?
*
What's a quick win that the viewers will get from listening to your interview:
*
Please tell me your story in a few words (150 words max.)
*
What would you like to get out of this experience (150 words max.)
*
What is the size of your email list?
*
I will have a microphone for this interview.
*
Yes
No
I will have a quiet environment to record the interview.
*
Yes
No
I hereby consent to the release and promotion of this series and my interview, conducted on behalf of CBWR Group.
*
Yes
No
I will be able to provide photos, videos and/or behind-the-scenes footage for my episode
*
Yes
No
I agree to send out 1 email mention to my entire email list and at least 1 social media promotion during the week my episode is released.
*
Yes
No
I acknowledge that Crystal Miller and CBWR Group bear no liability for any statements made by me throughout this series.
*
Yes
No
I would also like to be featured on the marketplace
*
Yes
No
Submit
Should be Empty: