202060 Customer Info Form

I need a form to go on my web site on it's own page. When I tried to write it myself, using the PHP mail() function, I couldn't get it to work.

I do not know what language you should program it in. I do know that there is not a cgibin directory on my site.

For examples of this script, email me.

I use dreamhost as my hosting service, if that helps any.

The form will ask the following information from a visitor, and send it to my email:

Name:

Company Name:

Address:

City:

State:(drop-down box)

Zip:

Telephone:

Fax:

Email:

Type of Business:

1. List your major products/services and prices/fees (or fee range) for each: (text area)

2. Who is your target audience? (text area)

3. How do you get business now? (Please check all that apply.)

(check boxes)

• Cold Calls

• Referrals/Networking

• Repeat Business from Old Clients

• Yellow Pages

• Direct Mail Letters

• Advertising

Where?

• Seminars That Your Customers Attend

• Your Sales Force Provides Leads/Customers

• Trade Shows

• Other (text box)

4. What is the largest amount of product/sales you've ever sold in one month? (text area)

5. What is a realistic percentage increase in sales, or number of new sales leads that would make you happy? (text box)

BUSINESS GROWTH SCENARIOS: Chose One or More of the Following:

(radio buttons)

6. Would you like more customers/clients per month paying the same amount most of your customers/clients pay now?

• Yes • No

7. Would you like the same number of customers/clients per month paying a higher amount than your typical customer/client pays now?

• Yes • No

8. Would you like the same level of business (same average payment size, same number of customers/clients) you have now, but more profit per customer/client?

• Yes • No

9. Would you like more of a certain kind of customer/client but not all types of customers/clients?

• Yes • No

Current Marketing and Sales Campaigns

10. Please rank, in order, the sales and marketing activities that take the most time and/or cost the most money each month. Start with the largest-investment sales and/or marketing activity.

(text area)

11. Which activities are the most effective now in terms of return on investment?

(text area)

12. How do you know the answer to the previous?

(text area)

13. Which activities are the least effective now in terms of return on investment?

(text area)

14. How do you know the answer to the previous?

(text area)

15. On a scale of 1 to 10 (1= not ready, 10 = ready right now), how ready are you to invest in a customer-generating marketing system that will lower your marketing costs and increase the growth of your business?

(text box)

If any question does not apply to your business, feel free to skip it.

Thank you for completing this survey. All information included will be considered confidential.

Please click this button to send this information to Kevin Dawson for a free consultation: (button text: Send to Financial Copywriting)

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Project ID: #1948283

About the project