Agency Intake Form - Super Connector Media

Super Connector Media Questionnaire - Help us get to know you!

Full Name*

Company*

Email*

Phone*

Website*

Job Title

Why PR, why now?

Have You Worked with a PR Firm Before?

Have You Gotten Media in the Past?*

Yes, a lot

Yes, a little

What's Your Estimated Annual Revenue?*

What is the Size of Your Internal Team?*

Notes

How Did You Hear About Us?*

Please provide referral detail: