Membership Application Form

183 Broadway Suite 310

Hicksville, New York, 11801

516 -942-0015
New Customer Survery

To apply for review please complete all questions.
Name*

First NameLast Name
Company*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
E-mail*
Work Number*

Area CodePhone Number
Cellular Number

Area CodePhone Number
Fax Number

Area CodePhone Number
Website
Industry: *
TMG Sales Rep:*
My Target Market:*

Retail (online only)Other BusinessesConsumers (one on one Consulting/Training/Counsel)
Tell us who are some of your trusted sources for your industry information
Tell us about your achievements/ credentials/ licenses/ background
In business how long:*
Tell us about your interests and hobbies
I currently have:

LinkedInGoogle+BloggerTwitterFacebookInstagramPinterest
You would like to have

LinkedInGoogle+BloggerTwitterFacebookInstagramPinterest
What would you like to go out of social media

Promote my brand/Increase sales/New clientsEngage with clientsAn online presenceMore "likes"NetworkingPromote my sales and specials
How often do you currently post?
How far in advance do you plan your marketing strategy?
How involved do you want to be with our social media
Check all that apply

Help! I set it up but don't know what to do nextI want to set this up, but I don't know howI have this under control, but need help with the campaignOther
If other please explain:
Tell us anything else that you think is important?
Provide us with an image to use with social media that is associated to your business

Upload a File

Cancelof
Should be Empty:

New Customer Survery