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UPSCALE YOUR BUSINESS

WITH LEGACY POWERHOUSE

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Intake Form

Please fill out this intake form to prepare our consultants for your appointment.

First name*

Last name*

Company name*

Email*

Phone*

Are you interested in creating a new business or re-establish an existing business? *

New business

Existing business

What type of business do you have? LLC, sole proprietorship, partnership etc.

EIN

Preferred method of contact:*

Phone Call

Text Message

Location of Business

Time Zone

Industry:

Website URL

Briefly describe your business*

What type of services are you interested in?*

Branding & Advertising

Business Consulting

Building Business Credit / Grants

Business Bundle Mini (A little of all services offered)

Business Bundle (Everything offered for consulting & helping run your business)

What do you hope to achieve working together?

Have you previously used similar services? If so, please provide details.

Do you currently have any in-house resources dedicated to the services needed? If so, please provide details.

Do you have any concerns or initial questions?

What are your main challenges or pain points in relation to these services?

What are your goals for the next 6 months? The next year?

What is your budget?

Is there any flexibility in your budget?

Yes

What payment methods do you prefer?

When would you like the services to start?*

What is the expected timeline for the completion of these services?

Is there a specific deadline that must be met?*

Yes

Is there any additional information you would like us to know?

How did you hear about us?

Email Agreement*

I agree to receive emails about updates, offers, and services.

Phone:

850-816-0371

Email:

info@legacy-powerhouse.com

Address:

1992 Lewis Turner Blvd,

Fort Walton Beach, FL 32547

Hours:

Mon-Thurs 9AM - 3PM

Friday 8AM - 12PM

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