Industry

Kind of Business Kind of Business Commercial (B2B) Residential (B2C) Both

How long in business?

How long in industry?

Number of Employees:

Owner/Applicant’s Name:

Business Name

Business Address

City/State/Zip

Business Phone

Cell Phone

Email Address

Website

Social Media Addresses

The following questions are meant to allow us to better get to know you. Your answers do not disqualify or better qualify you in complementing the Cindy’s CHOICE culture. The following questions are meant to allow us to better get to know you. Your answers do not disqualify or better qualify you in complementing the Cindy’s CHOICE culture.

Are you a member of any networking organizations? Are you a member of any networking organizations? Yes No

Please list organizations and length of membership:

Are you a member of any trade associations? Are you a member of any trade associations? Yes No

Please list organizations and length of membership

Do you currently serve on any non-profit boards? Do you currently serve on any non-profit boards? Yes No

Have you ever been convicted of a felony? Have you ever been convicted of a felony? Yes No

If yes, please provide details:

Are you looking to grow your business? Are you looking to grow your business? Yes No

If so, are you prepared for growth? If so, are you prepared for growth? Yes No

Do you believe that most consumers are intelligent and prefer to be treated as so? Do you believe that most consumers are intelligent and prefer to be treated as so? Yes No

Do you believe that most consumers are getting numb to the routine marketing gimmicks and trends? Do you believe that most consumers are getting numb to the routine marketing gimmicks and trends? Yes No

Business Reference Business Reference

Name

Please list any recognition awards or noteworthy acknowledgements.

Business:

Phone

Email

Years/Months Known:

Business Relationship:

Comments

Name (Business Reference 2)

Business:

Phone

Email

Years/Months Known:

Business Relationship:

Comments

Name (Business Reference 3)

Business:

Phone

Email

Comments

Business Relationship:

Years/Months Known:

Please feel free to send a bio, articles, or other information that you would like to send to help us get to know you better to info@CindysCHOICE.com Please feel free to send a bio, articles, or other information that you would like to send to help us get to know you better to info@CindysCHOICE.com