Client Intake Form

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Client Intake Form

Clients who desire to pursue service with Urbanetectonics, LLC dba The BomaQ Companies must sign an initial client intake form. Potential clients may also opt to use our self-scheduler at our website to schedule a day and time to receive assistance in filling out this form or to schedule an appointment.

Email *

Name of the person(s) requesting service.

Name of the business, organization, or entity.

Contact Information: *

Select Industry: *

Design, Engineering, or Construction

Facilities, Hospitality, Food Service, or Retail

Education, Multi-Media, or Technology

Oil Gas, Healthcare, or Manufacturing

Business Brokerage or Managerial

Other:

Select Entity Structure: *

Sole Proprietor or Self-Employed

General Partnership

LLC, LLP, or PLLC

Professional Corporation, S-Corp, or C-Corp

Non-Profit, Public Agency, or Governmental Entity

Other:

Select Entity Stage:

Seed Stage

Early Stage

Mid Stage

Late Stage

Exit

Other:

Clear selection

Select Projected Enterprise Value:

< $25,000

$25,000 to $150,000

$150,000 to $350,000

$350,000 to $500,000

$500,000 to $750,000

$750,000 to 1.5 Million

1.5 Million to 3.5 Million

> 3.5 Million

Clear selection

Select Service & Need *

Operations & Logistics

Human Capital Training

Facilities Care & Planning

Project Compliance Legalism

Marketing & Public Relations

Multi-Media & Technology

Safety, Security, & Emergency Preparedness

Data Warehousing

Asset & Inventory Management

Project Direction and Management

Other:

Required

What is the projected or planned budget allocated for this service or need?

< $25,000

$25,000 to $150,000

$150,000 to $350,000

$350,000 to $500,000

$500,000 to $750,000

$750,000 to 1.5 Million

1.5 Million to 3.5 Million

> 3.5 Million

Clear selection

Is there time or schedule constraints or parameters that would impact favorable service delivery and fulfillment?

Yes

Other:

Have you sent ALL relevant support documents to information@urbanetek2.com which would support accurate quote, proposal, or service matching activities?

Yes

Other:

Initial Consultation Delivery Preference: *

On-Site Analysis and Assessment Walk Through

Marketing Meeting, Presentation, or Brown Bag Lunch n Learn

Video Conference Discussion on Service and Product Options

Email Questions about Contract Delivery, Signature, and Pricing Structure

Brochure, Marketing Materials, and a Follow-Up Phone Call

Other:

Required

Name three dates and times you would prefer to meet or indicate you will use our self-scheduler https://t.co/92vOQmEdgb which is also found at our website www.urbanetek2.com. *

I am the authorized signature of the Owner, Manager, or Administrator who has managing authority to make decisions on behalf of the said entity previously listed on this form: *

Yes

Other:

Required

Authorized Signature. Please sign digitally here: *

Indicate the Current Time: *

Time

Please indicate the date: *

YYYY

Send me a copy of my responses.

Submit

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