Initial Client Survey (Please fill out as much information as possible)



Contact Information
Name of Company
Name of Contact
Contact Phone (+ext.)
Contact e-mail
Alternate Contact
Alt. Contact Phone (+ext.)
Alt. Contact e-mail
Mailing Information
Address
Address 2nd Line
City
State
Zip
About Your Company
Does your company have a mission statement?
Does your company provide a service, a product, or both?Product | Service | Both
Is your product or service for wholesale or retail clientele?Wholesale | Retail | Both
Approximately how many customers do you provide product or service?
What do you sell?
Do you have an "800" number?Yes | No
Company "800" Number
What form of payment do you accept for your service or product (please check all that apply)? Cash
Check
Credit Card
Is it essential for a customer to come to your location to obtain your service or product?Yes | No
If so, why?
Do you have an order form for service or product?Yes | No
Do you have any forms that are routinely filled out?Yes | No
How many are they filled out by your staff?
How many are filled out by your client or potential client?
Are any of these forms then entered into a computer system?Yes | No
What kind of information do you have to obtain from a client or potential client?
Does your company have a technical support department?Yes | No
Are you planning to implement or expand technical support for your company in the near future?Yes | No





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