New Client Consultation Form
Thank You for considering our team for your next project!
Your Name
*
First Name
Last Name
Business Name
*
Today's Date
*
-
Month
-
Day
Year
Date
Industry
*
Business Website
Mobile Number
*
-
Area Code
Phone Number
E-mail
*
example@example.com
What is your Title within the company?
*
How did you hear about us?
*
Website / Online Search
Facebook
Instagram
Referral
Others
If Referral, please list name
If Other, please let us know
Online Consultation Schedule
*$50 Consultation Fee - Must be paid prior to Consultation* (Payment Options will be sent upon submission of this form - Payment Receipts will be emailed)
Preferred Date
*
Meeting Method
*
Virtual (Zoom, Google Meet, Teams)
In-Person
Email Correspondence Only
Tell us more about your business
When was your company started?
*
Are you a Virtual Business or Brick & Mortar?
*
What solution is your company looking to uncover currently?
*
Has your company faced in civil or criminal liabilities in the last 10 years?
*
When was the last time your company carried out an internal 'Strategic Planning Session'?
Which area(s) of expertise do you require our support?
*
Public Relations
Public Policy
Marketing (Including Social Media Marketing, Content Creation, etc.)
Grant Writing
Fundraising
Business Development
Other
I understand, have read and completed this questionnaire truthfully. I agree that this constitutes full disclosure, and that it supersedes any previous verbal or written disclosures. I understand that withholding information or providing misinformation may result in contraindications and/or negatively impact project results and services received. I also understand and fully accept that a $50 Consultation Fee must be paid via Zelle, paypal, cash app, venmo, and/or other payment platforms deemed sufficient. I also understand that the consultation fee is 100% non-refundable and/or transferable. I also understand that the consultation fee does not and is not included in package/service packages.
Yes
Signature
*
Submit
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