Business Information Form

This form registers your company and helps us to gain a better understanding of our consumers.

Registrant

First Name *

Last Name *

Address 1 *

City *

State *

Zip *

Phone *

Email Address *

Product Information

Name Of Business *

The products or services I sell are *

Average Price Per Sale *

Average Number of Sales Per Month *

Business Start Date +

Mission Statement *

Business Strengths/Value Proposition *

Education / Years of Experience In This Business *

Current Annual Revenue *

Type of Ownership *

Please check the areas in which you need assistance
in developing or building. *

How Do You Sell Your Product or Service?

Alotted Budget *

Age Range

Preferred Client Gender

Male

Female

Target's Marital Status

Married

Single

Does Your Client

Own

Rent

Which best describes
the client's family income?

Client's Education:

Your Ideal Client May Also Have An Interest In

Sole Proprietorship	Corporation	Partnership
LLC	Other Other

Automotive work	Bible/devotional	Boating/sailing
Camping/hiking	Casino gambling	Contribute to charitable causes
Crafts	Cultural art/events	Cycling
Do-it-yourself	Enter sweepstakes/contests	Fishing
Fitness/exercise/jogging	Gardening	Golf
Gourmet cooking/food/wines	Grandchildren	Home decorating
Hunting/Shooting	Investments (mutual funds, IRA's)	Investments (stocks & bonds)
Movie watching	Own a cat	Own a dog
Snow skiing	Self improvement	Soccer
Tennis	Travel - Foreign	Travel - U.S.
TV shopping	Vitamins/natural foods	Watch sports on TV