Customer Intake Form 1 Contact Info 2 Company Details 3 Brand Resources 4 Next Steps Contact Info - Step 1 Company Information Company Name textbox7630 Street Address textbox6726 City textbox4077 State textbox6929 Zip textbox8690 Phone Number (for customers) textbox9949 Website URL textbox1317 Contact Person Information First name preptext2620 Last name textbox9330 Email address preptext3906 Phone number textbox6129 Cell Office radiobutton6905 Title/Position textbox3209 Preferred Method of Contact Email Phone Other person preferred-contact Preferred Contact Name prefcont-name Email prefcont-email Phone Number prefcont-phone Prev Next Company Details - Step 2 Describe the Nature of Your Business textarea8066 Describe Your Ideal Customer textarea4411 Number of Years in Business textbox1450 Number of Employees textbox7047 Prev Next Brand Resources - Step 3 Logo File (EPS preferred) Select image Change Remove fileupload9942 Primary Brand Color colorpicker8566 Secondary Brand Color colorpicker4667 Image Gallery URL textbox1028 Does this image gallery require a login? Yes No radiobutton1938 Username textbox2473 Password textbox2071 Upload Images* *You must have the rights to use these images in advertising. Select image Change Remove imageupload2169 Prev Next Next Steps - Step 4 We are excited to have you join our family of advertisers. Please submit this form and we will follow up shortly.Kind Regards,Cityview Magazine Submit ‹ › × × ×
