Contact Person Name

First Name

Last Name

Contact Phone

(###)

###

####

Business Type:

(Select one)

Retail

Service

Restaurant

Other

What is your estimated annual revenue?

(Select one)

<$50,000

$50,000 - $100,000

$100,000 - $250,000

$250,000+

Have you received any grants or funding in the past year?

Yes

No

What types of marketing have you used in the past?

(Select all that apply)

Social Media

Email Marketing

Print Advertising

Other

Are you interested in discounted media and marketing services?

Yes

No

What specific services are you most interested in?

(Select all that apply)

Social Media Management

Graphic Design

Website Development

Other

Would you be open to trading goods or services in exchange for marketing services?

Yes

No