Creative And Marketing Information Request

Client*

Your Email*

Is This A Renewal Of A Client On The Air Now?*

Yes

No

Are There Any Proposal Changes To The Existing Program?*

Yes

No

Note Proposal Changes Needed:*

Highway To Success Proposal Number

1

2

3

4

Client Specific Concerns On Latest Proposal

The Phrase That Pays*

No One Else In The Marketplace CAN*

What’s The NUMBER ONE Way Consumers Should Touch Your Client?*

Address

Website

Social Media

Phone

What’s The NUMBER TWO Way Consumers Should Touch Your Client?

Address

Website

Social Media

Phone

Exact Street Address

Any Address Description? (Next To, Across From)

Website

Social Media

Phone (Rarely Used)

Area Code

Phone Number

Branding Line/Slogan*

The Buying Decision On This Product/Service Is Most Often Made By

A Woman

A Man

The Client Wants More Customers Who Are*

30 Or Younger

30-40

30-50

45 Or Older

The Client Wants More Customers Who Are*

Tell Us Where Da Sale Happens*

Specifics On Creative Approach

Specifics On Proposal Approach

Month Proposal To Begin*

Month Proposal To End*

Proposal Dollars Range*

From

*

To

Renewal Dollar Amount*

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