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Name
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First Name
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Last Name
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Title
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Company
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Company Website
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Current Mailing Address (Home or Office - Where ever you are getting mail these days)
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Address Line 1
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When would you like to begin using our service?
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ASAP
Next Week
Next Month
2-3 Months
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7-11 Months
1+ Year
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Please list your company values and/or mission
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Overall how would you rate your level of brand awareness?
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Excellent: National - Unaided brand awareness
Very Good: National - Aided brand awareness
Good: National - strong awareness with core demographic
Fair: Regional Awareness
Poor: A few people know my brand
Other:
Other Value
What product categories or brand extensions do you see for your brand?
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What brand(s) do you want to license out?
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How did you hear about us?
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Friend/Colleague
Search Engine/ Google
Licensing International
Trade Show
Other:
Other Value
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