Contact Information

Purpose: Establish communication and understand the business basics.

First Name *

Last Name *

Email Address *

Phone Number *

Company Name *

Job Title/Role

Company Website

Preferred Contact Method

Phone

Text

Best Time to Contact

Business Profile

Purpose: Understand the business context, size, and industry to tailor solutions appropriately.

Industry/Business Type *

Years in Business *

Number of Locations

Single Location

2-5 Locations

6-10 Locations

11+ Locations

Service Area *

Annual Revenue Range

Number of Employees

Current Marketing Budget (Monthly)

Current Digital Presence & Challenges

Purpose: Assess existing infrastructure and identify pain points to address in the proposal.

Do you currently have a website? *

Yes

Under Development

Do you currently use any AI tools?

Yes (specify)

Not sure

Project Goals & Requirements

Purpose: Understand specific objectives and desired outcomes to align proposal with business goals.

Target Keywords/Search Terms

Do you need e-commerce functionality? *

Yes

Maybe in the future

Do you need multi-language support?

Yes (specify languages)

Specific Features/Integrations Needed

Budget & Package Interest

Purpose: Qualify the lead and understand budget expectations to propose appropriate package tier.

Budget Range for Initial Project *

Are you interested in ongoing monthly support? *

Yes

Want to learn more

Additional Information

Purpose: Capture any additional context and set expectations for next steps.

Who are your main competitors?

What makes your business unique?

Have you worked with marketing agencies before?

Yes, currently working with one

Yes, in the past

No, this would be our first time

Additional Comments or Questions

How did you find us?

Would you like a free AI audit? *

Yes, include free AI audit

No, just the proposal

By checking this box, I consent to receive non-marketing text messages from [BUSINESS NAME] about [USE_CASE_FROM_CAMPAIGN_DESCRIPTION]. Message frequency varies, message & data rates may apply. Text HELP for assistance, reply STOP to opt out.

By checking this box, I consent to receive marketing and promotional messages including special offers, discounts, new product updates among others.from [BUSINESS NAME] at the phone number provided. Frequency may vary. Message & data rates may apply. Text HELP for assistance, reply STOP to opt out.