Request Information from Wordspecs Advertising Agency

Please provide the following information.

Disclosure: The information below is strictly confidential. The purpose of this questionnaire is to expedite your literature request and materials samples.

Organization Information

Organization Name
Ownership	Public Private Nonprofit
Year Established
Organization URL

Contact Information

Contact Name
Contact Title
Contact Phone
Contact Fax
E-Mail address
Street Address
City	State
Zip code	Country

Advertising History

Have you used an ad agency in the past?	Yes No
What do you use to promote your organization? (Please check all that apply.)	Color Space Ad TV Commercial B&W Space Ad Video Web Banner Ad Web Site Newsletter Catalog/Sales Sheets Direct Mail Other (please describe):
What kinds of services might you need? (Please check all that apply.)	Concepts Illustration Copywriting Photography Art Direction Digital Scans Production PDF Document Conversion Consultation Web Design Search Engine Submission Dynamic Web Content Other (please describe):

Product/Service Information

What kind of product or service do you provide?
Who or what are your competitors?

Customer Demographics

Please describe your typical customer/client.

Male Female Age Range Customer Household Income Living/working where? Additional comments:

Professional Network

Do you participate in any business-to-business networking? (Please check all that apply.)

Chamber of Commerce Professional Association Service Organization Referral Program Commission Other networking:

Preferences

Requests	Call me E-Mail me Schedule an appointment Do nothing 'til you hear from me!
Anything else?