Name
*
Title
Email
*
Phone
*
Company Name
*
Ticker Symbol
MarketCap
*
$
Industry
*
Current Issued and Outstanding Shares:
*
Float
*
Fully Diluted Issued and Outstanding:
*
Capital Requirements over next 12 months:
*
Do You Have Any Warrants Outstanding
*
Yes
No
IF YES, List Quantity and Price of Outstanding Warrants
*
Current Annual IR Budget
*
$
Have you Attempted Digital Retail Outreach or “Promotion” in the past?
*
IF YES, Please List the Most Recent Efforts and Amounts
*
What Would Have to be True in 6 Months for this to be Considered a “Success”?
*
Who will be involved in the Decision Making Process for this Engagment? (check all that apply)
*
CEO
CFO
Board
Director
Consultant
Other...
Ideal Date To Start?
*
Are You Willing to Commit the Time and Resources to Succeed? (Minimum $500K media budget to start)
*
Yes / No
Yes
No
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