Company Name 

Contact Name    

Contact Title 

Address: 
Address: 

City:    ST    Zipcode   

Phone (xxx-xxx-xxxx):

Fax (xxx-xxx-xxxx)   Email

Web url

Briefly describe your organization (products/services, retail or wholesale)

Briefly describe your target market 

Briefly describe your Unique Value (Selling) Proposition 

Length of time in business (years)   Number of employees   

Do you have a dedicated marketing dept? Yes No

Do you have a marketing budget? Yes   No           

Do you have a Mission Statement?  Yes   No 

If so, what is your mission statement?

What are your immediate goals and objectives? 

What are your long-term goals/objectives?        

What are your strengths? 

Your weaknesses?          

Do you have a strategic marketing plan?  Yes  No   

Do you participate in social media network sites? Yes    No 

If yes, briefly describe your participation (ie, twitter, facebook, blogs, etc)

Do you have a strategic Social Media Marketing Plan? Yes No      

Do you have a prospect database? Yes No   

Do you send marketing emails? Yes No   

Do you currently have a newsletter? (electronic and/or print) Yes No

What are you looking to learn from this Needs Assessment Review?

Any other thoughts, questions, comments.

Add me to your mailing list

When you hit the submit button it should redirect to a thank you page. If not, please check the form again for any errors in red, and correct them. Thank you

 Reset Form            SUBMIT FORM