Consulting Client Intake Form Template

Unique Expressions Management LLC

New Client Consulting Intake Form
Disclaimer: As a potential service provider for your company, please realize that Unique Expressions Management, LLC is interested in acquiring information about your company in order to accurately evaluate your company's needs and provide you with quality service. All information provided by your consulting agent is secret and proprietary. We shall not divulge or use your information for any reason other than to provide you with proper service and consultation. Please complete this questionnaire and provide detailed responses so that we can better assist you. Your responses will ensure that we can immerse ourselves in your business in order to better serve and meet your needs. If you have any questions or issues, please contact us right away. Thank you for for you your time and acknowledgement.
Contact Person Filling Out Form:*

First NameLast Name
Position/Title:*
Phone Number*

Area CodePhone Number
E-mail*
Preferred Method of Contact:*
When is the best time to contact you?*
How did you hear about us?*

WebsiteSocial MediaFriendAdvertisementReferredOther
Business Information
Name of Business, Company, Organization, or Brand*
Business Description:*
Nature of Business
Business Category:*
Industry/ NAICS Code(S)
Annual Revenue Estimate:*
How long have you been doing business?*
Tax Classification:*

Name(s) of owner(s), partner(s), or proprietor(s)*

	Name	Title	% of Ownership	Date of birth	SSN	Phone	Email	Address
Name

Name(s) of owner(s), partner(s), or proprietor(s)*

	Name	Title	% of Ownership	Date of birth	SSN	Phone	Email	Address
Name

Number of Employees:*
Business EIN:*
Business E-mail*
example@example.com
Business Website
example@example.com
Business Number*

Area CodePhone Number
Business Fax

Area CodePhone Number
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Mailing Address if different

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Name of CPA/Tax Accountant:
CPA/Tax Accountant Phone Number or Email:
How can we Help?
Name 1 - 3 things you need help with.*
List requests in the box above
Name 2 passions that you have.
Name 2 goals for this need.
How long have you spent on this endeavor?
Please check the areas where you feel our assistance is needed to help grow your business and reach your goals.*

Marketing/AdvertisingBranding/Image ConsultingSocial MediaWebsiteProfessional Accounting and Billing SupportBusiness DevelopmentManagement Consulting ServicesPersonal Concierge ManagementPrivate Practice ConsultingCredentialing ServicesProfessional Organizing ServicesProfessional Training and HR SupportBusiness Startup and Consulting ServicesBack Office Consulting And Support ServicesProperty ManagementBusiness MentoringProject ManagementProfessional Document Preparation ServicesOther
Describe your business product or service:*
Who is your target market?*
How would you describe your present customer? Describe demographics, geography, and so on.*
What message do you want to send to your present and potential customers?
What are your finance options for securing our services? What is your estimated budget for the services you're looking for?
Do you want to hire us on a retainer or by the hour?
When would you like to get started? List approximate or exact date?
Marketing Needs
What are the goals of your marketing strategy? As an example. Branding, awareness, sales, and so on.
What do you consider a success at the end of this a goal in mind?
What is your marketing budget? Do you want to advertise weekly, monthly, quarterly, or annually?
Unique Expressions Management LLC has the right to limit services to persons, businesses, and organizations best suited to our agency's goal and vision. The agency will endeavor on behalf of its clients to establish relationships with contacts supplied in order to best serve its clients' overall goals. Unique Expressions Management LLC's goals are to deliver quality and professional services to all clients in the design, execution, promotion, and creation of successful business development, marketing, and sales.
I acknowledge that I have read this client intake questionnaire form and have agreed to disclose information on it for the purpose of evaluation and consultation services provided by Unique Expressions Management LLC.
Company Name:*
Signature*

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Thank you for taking the time to consider Unique Expressions Management LLC as a potential business consultant and partner! We are excited about the opportunity for working with you.
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Unique Expressions Management LLC

Business Information

How can we Help?

Marketing Needs