Proburb - Client Qualification Form

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Business Fundamentals

Business Name *

Your Email *

Which cities/areas are you targeting for leads?

Which state(s) do you primarily serve? (If multi-state, list them)

Option 1

How long have you been in business? *

Are you a franchise?

Yes

Clear selection

What is your annual revenue? *

What is your estimated monthly budget for dedicated advertising? *

How is your business currently performing? *

Struggling to find new clients/business

Steady, but looking for significant growth

Growing, but inconsistently

Thriving and looking to scale further

Please describe your current marketing efforts, and what results are you currently getting from them? : *

What is your major source of new business today? *

Referrals

Physical Networking Events

Social Media Networking

Paid Advertising (e.g., Google Ads, Facebook Ads)

Organic Search (SEO)

Email Marketing

Trainings / Workshops

Direct Mail

Other

Other:

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This form was created inside of BizCrown Media.