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Vendor & Customer Information Form

Information disclosed by the client (current and/or potential)
will be handled in confidence. Gallagher & Gallagher ("Firm")
agreesnot to disclose any client-provided information to third parties.
Likewise, the Client acknowledges and agrees that any consultation,
quote specifications, or pricing offered during meetings or in subsequent
proposals are a valuable commodity to the "Firm" and agree to treat all
such information in confidence and not to record, otherwise make copies,
or distribute any portion thereof. All materials and concepts are copyrighted
by Gallagher & Gallagher, Inc. for private use only and may not be
communicatedor transferred without permission.


 
Client Name:

Company:

Phone:

Address:

City:

State/Zip:
  
E-mail 1 :

E-mail 2:



1. Type of Business

Sole
Partnership
Corporation



2. Years in Business

1-5
5-10
10 or more



3. Marketing Tools already in place

Logo
Identity Package
Brochures
Newspaper Ads
Magazine Ads
Newsletter
Radio Ads
T.V. Ads
Direct Mail
Marketing Communication Plan
Branding
Other
None


4. What specific services are you seeking
from Gallagher & Gallagher?





5. How did you hear about our firm?




6. What is your anticipated budget (required)?





7. What is the best time to reach you?




 




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