1) My marketing objectives and responsibilities are:
(Please check all that apply.)
Build loyalty and strengthen customer relationships
Retain customers
Reactivate customers
Acquire new customers/generate referrals
Cross-sell products/services
Increase sales
Differentiate our company from competitors
Reward best customers
Other (describe)

2) We currently communicate with our customers via:
(Please check all that apply.)
Direct mail
Statement-inserted promotions/product offers
Newsletter
Circulars, ROP or inserts
E-mail
Web site
Fax-On-Demand
Other (describe)

3) My areas of greatest need:
(Please check all that apply.)
Customer database segmentation and analysis
Strategic consulting and program design
Creative development and execution
Other (describe)

4)	I am open to looking at fresh strategies and testing methods and concepts in order to increase revenues and customer profits.

Yes
No

5)	I would like to set up a 30-minute presentation to learn how CCG can help my company increase revenues and enhance profitability.

ASAP
In 30 days
31 – 60 days
Other (describe)

Thank you for taking the time to provide this information.
I will be in touch with you soon.