Thank you for selecting Emmersion Marketing for your small business needs! We are delighted to welcome you as a new client and look forward to our future together. While we know forms aren’t always the most fun to complete, we want to ensure we know as much about your business and your goals as possible. If you’re a new or returning customer, please take a moment to complete this form.

Business Name
Business Point of Contact
This would most often be yourself
Last Name
First Name
Point of Contact Phone
Best phone number to reach you
(###)
###
####
Point of Contact Email Address
Other than yourself, who is permitted to request changes on your account?
Business Address
Address1
Address2
City
State/Province
Zip/Postal Code
Country
Business Website Address
Business Email Address
Where should contact forms or inquiries go?
Business Phone Number
(###)
###
####
How would you describe your services or products?
What makes your product/service unique from your competitors?
What would you say are your biggest struggles when it comes to marketing and advertising?
If you have any technology or business administration struggles, please list these here as well.
How would you describe your target audience?
Or, who would you like your target audience to be?
What businesses are your biggest competitors?
Or, what businesses would you like to be more like?
Are you satisfied with your current website?
If not, what would you change?
Have you used Google Adwords in the past?
Yes
No
What would you like to see change for your business from working with us?
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emmersion 2016