Corporate-Love Intake Request

Thank you for your interest in Corporate-Love through a Love Strategy/Campaign!

For us to better serve you, please provide us with a bit

of information by filling in this form with the contact

details of the best person for us to connect with.

We will get back to you as soon as we can. Thanks!

Thank you for your interest in Corporate-Love through a Love Strategy/Campaign!

For us to better serve you, please provide us with a bit

of information by filling in this form with the contact

details of the best person for us to connect with.

We will get back to you as soon as we can. Thanks!

Full Name

Phone Number

Position within the company

Please describe your current corporate culture.

Best Time You Can Be Reached (Select All That Apply):

	Monday	Tuesday	Wednesday	Thursday	Friday	Monday	Tuesday	Wednesday	Thursday	Friday	Monday	Tuesday	Wednesday	Thursday	Friday	Monday	Tuesday	Wednesday	Thursday	Friday
Morning
Afternoon
Evening
Morning
Afternoon
Evening
Morning
Afternoon
Evening
Morning
Afternoon
Evening

Who makes the decisions?

Company's Name

Industry

Company's Website (Optional)

How many years have you been in business?

How many EMPLOYEES do you currently have (roughly)?

1-10

11-50

51-199

200+

How many CUSTOMERS/CLIENTS do you currently have (roughly)?

1-10

11-50

51-199

200+

Have you run a Corporate-Love or Self-Love campaign before?

Yes

Please explain:

Have you run a Mental Health campaign before?

Yes

Please explain:

Do you have any ideas that you would like to implement?

Yes

Please explain:

Best Time You Can Be Reached (Select All That Apply):

	Monday	Tuesday	Wednesday	Thursday	Friday	Monday	Tuesday	Wednesday	Thursday	Friday	Monday	Tuesday	Wednesday	Thursday	Friday	Monday	Tuesday	Wednesday	Thursday	Friday
Morning
Afternoon
Evening
Morning
Afternoon
Evening
Morning
Afternoon
Evening
Morning
Afternoon
Evening

What is the biggest problem you face corporately?

Please describe your current corporate culture.

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