Name: Title: Company: Street Address: Additional Street Address: City: State: Zip: Country: Phone Number: Fax Number: E-Mail Address: How did you hear about Passaic Parc? Comments: Important: to qualify, please answer these questions: 1. Our marketing programs involve these products/services (briefly describe): 2. We presently run marketing programs using these media (check all that apply): Direct mail Magazine advertising Newspaper advertising Catalog Web/Online/CD-ROM Other 3. Our prior marketing efforts may be categorized as (check all that apply): Lead generation One-step direct marketing Seminar program Traffic building Other 4. We're planning to develop a new marketing campaign using these media (check all that apply): Direct mail Magazine advertising Newspaper advertising Catalog Web/Online/CD-ROM Other No current plans 5. When will you begin working on your next marketing campaign? Within 30 days In 1-3 months In 3-6 months In 6-12 months No plans 6. What is your total marketing budget for the next 12 months? (across all media) Less than $25,000 $25,000 - $49,999 $50,000 - $99,999 $100,000 - $249,999 $250,000 - $499,999 $500,000 - $999,999 $1,000,000 - $2,499,999 $2,500,000 - $4,999,999 $5,000,000 + To send in this form, press: