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Business Intake Form
Mississippi AI Agency
11
Questions
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1
Full Name
First Name
Last Name
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2
Mobile Number
Please Confirm a mobile number that can receive texts
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3
Your Email Address
The Email You Actually Read
example@example.com
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4
Business Name
That name that the public recognizes you by
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5
How many employees do you have?
0-3
4-8
More than 8
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6
Which services are you interested in?
Tech Needs Assessment
Graphic Design and Marketing
Technical Assistance
All
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7
Please tell us about your business and the services you may be interested in
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8
What is your annual budget for technology?
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9
Who supports your website/social media/online presence?
I don't have one
Hired Designer/Developer
Hired Maintenance
I provided the content
The content was created for me
Other
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10
What are you wanting people to do when they find your business?
Book Services
Buy Something
Get an estimate
Find Information/Self Help
Other
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11
How did you hear about us?
Social Media
Internet Advertising
Word of Mouth
Other
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