| First Name: |
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| Last Name: |
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| Business Name: |
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| Address Street: |
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| City: |
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| Zip Code: |
(5 digits) |
| State: |
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| Daytime Phone: |
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| Sales Representative: |
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| Email: |
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| How would you rate your experience with InLineAdz thus far? (Host Only) |
Sales Process:
Excellent Average Poor
Installation:
Excellent Average Poor
Follow Up:
Excellent Average Poor |
| Any Comments? |
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| Please give us your response to the presentation and opportunity presented. (Advertisers Only). |
Sales Process:
Excellent Average Poor
Design Process:
Excellent Average Poor
Follow Up:
Excellent Average Poor |
| Any Comments?: |
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| Would you advise your family, friends or business associates to advertise with InLineAdz? |
Yes No |
| If No, please explain |
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| Would you at this time like to provide a testimonial? Please specify if it will be written or video.We will contact you for video testimonal |
Written Video |
| Written Testimonal: |
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| Any other comments you would like to provide us? |
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