Contact Strategic Impact!
Full Name:
Company:
Public
Private
Position:
Address:
City:
State:
AK
AZ
AR
CA
CO
CT
D.C.
DE
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
Zip:
Phone:
Email:
Industry:
Market:
Annual
Revenues:
Please select all services you are interested in:
Marketing Planning and Strategy
Web and E-commerce
New Business Development
Print
Creative Production, Copy and Design
Client Relationship Management
Media and Press Publicity
Referral Tactics
Direct Response Campaigns
Other
Briefly describe your project:
Have you ever worked with an agency before?
Yes
No
How did you here about us:
Select One
Advertisement
Affiliate / Partner
Associate / Friend
Broadcast Fax
Called In
Direct Mail
Email Campaign
Internet Banner Ad or Link
Networking or Professional Group
News or Media Outlet Coverage / Story
Newsletter / Hand-Out / Flyer
Newspaper / Magazine
Non-Profit Organization
Other
Personally met you
Phonebook / Directory Assistance
Radio
Read your Advice / Column / Article / Story
Referral
Search Engine
Seminar / Event / Tradeshow
Signage / Billboard
Telemarketing
Television / Cable Network
Word of Mouth