CLIENT INTERVIEW FORM
Company Name
*
Client Name
Segment paid for by:
*
Client, 3rd party (provide name), n/a (not applicable)
Account Executive
*
Amanda Corey
Cathlene Snyder
Mandy Moore
Paula Phillips
Shaun McGrath
Brooke Turpen
Tim Sanders
Rick Semmler
Kassidy Glassburn
Marty Ledbetter
Jordan Butts
Jermaine Smith
Conner Williams
Name of Account Executive
Company Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Company Social Media (List as many or "None")
*
Social Media Links
What URL landing page would you like for your QR Code?
Example: https://www.mywabashvalley.com/gdl/
Company Bio
*
Website
*
If none, please confirm
Shoot Location
*
Shoot Date
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Shoot Time
*
1
2
3
4
5
6
7
8
9
10
11
12
:
Hour
00
10
20
30
40
50
Minutes
AM
PM
AM/PM Option
Is The Client Bringing Props
*
Are there any accommodations needed for guests?
*
Who will be interviewed? Title?
*
Will you be bringing any video or prior footage that we may be able to use?
Yes or No
Client/ Advertiser Email
If Different From Form Entry Email
On Screen Phone Number
-
Area Code
Phone Number
Topic of discussion and why?
*
Areas of Interest to Discuss
Does the client have any must ask questions?
*
Items/Areas for video
When is the best time to reach you with questions?
Would you like a copy of the story sent to you via email or hard copy delivered? (Please Specify)
Would you like a copy of the story sent to you via email or hard copy delivered? (Please Specify)
Enter the message as it's shown
*
Submit
Should be Empty: