Client Questionnaire 

Please complete the brief client questionnaire below.

If you have questions, or would like more information, please leave your name and contact information. Contact Ty Young at tyyoung@tymediagroup.com
If you have questions, or would like more information, please leave your name and contact information.

First Name:
Last Name:
Business Name:
Client Name:
Corporation
Non-Profit
Sole Proprietor
Do you have a partner/s:
Name of Partner/s:
Email Address:
Business Phone:
Cell Phone Number:
Address:
City:
State:
Zip Code:
Do You Have a Website:
If Yes What Is Your Website Address:
Website Comments:
Your Ideal Client/Customer
Monthly Income Goal:
Vision:
Mission:
Problem Your Business is Solving:
Current Marketing:
Products or Services you offer:
Do you have a Marketing Plan:
Have you ever published or authored a book:
Would you like to write a book if you had support:
Comments:
Security code:
 *
Do not enter anything in this field:

* indicates a required field