1 / Length of your radio schedule (number of weeks)
2 / How many spots per week
1-6
7-12
13-18
19-24
25+
3 / Is there a streaming component?
Yes
No
4 / Will it be backed with a click response on the station webpage or are we sending people to your website ?
Station Webpage
Client Website
Neither
► DATE RADIO COPY TO BE DELIVERED (if copy done live, just write ‘0’)
5 / Do you have a theme/slogan you wish to carry through radio/ social media?
Yes
No
► IF ‘Yes’, PLEASE PROVIDE HERE ( maximum 20 words)
6 / Do you have a website?
Yes
No
► IF SO, INDICATE THE ADDRESS www.
PLEASE WRITE A SHORT BIO ABOUT YOURSELF, A GUIDE MIGHT BE TO DESCRIBE WHO YOU ARE, WHAT YOU DO, WHY YOU CREATED YOUR BUSINESS OR WEBSITE, SOMETHING PERSONAL THAT SAYS SOMETHING ABOUT YOU. (maximum 150 words)
►In a separate email, please send a .jpg or pdf of your LOGO along with a PHOTO of yourself
7 / What are your goals? (check three that apply)
► IF YOU CHECKED ‘OTHER’, PLEASE EXPLAIN HERE (max 50 words)
8 / Who are you trying to reach? (check the main group you wish to target)
Under 12
12-18
18-34
35-44
45-54
55-64
65 and over
SEX
Male
Female
Both
9 / IF YOU WANTED A SECONDARY MARKET, WHO WOULD THAT BE..? (check one)
Under 12
12-18
18-34
35-44
45-54
55-64
65 and over
SEX
Male
Female
Both
10 / What percent of NEW business do you want your social media/radio to drive?
(check one please)
0-10%
10-25%
25-40%
40-60 %
60-80 %
80-100%
11 / What percent of EXISTING business do you want social media/radio to reach and inform?
(check one please)
0-10%
10-25%
25-40%
40-60 %
60-80 %
80-100%
12 / Do you understand how your target or prospective customer uses social media?
Yes
No
13 / Do you want a large amount of followers, or fewer but more targeted followers?
Large Amount
Fewer more targeted
14 / What's your online relationship with the audience today? (click as many as apply)
► IF YOU CHECKED ‘OTHER’, PLEASE EXPLAIN HERE (max 50 words)
15 / Do you know what your audience knows about YOU today?
Yes
No
IF ‘Yes’, PLEASE EXPLAIN (limit 50 words)
16 / If you could target any three groups of customers (ex: STAY AT HOME MOMS, TEENS, SINGLE WOMEN WHO EARN $35,000, NASCAR FANS) who would they be?
(Please list in order of importance to your business)
17 / How often would you like to change the basic message you send to customers new and old? (SPECIALS, NEW ITEMS, NEW EMPLOYEES) (choose one of the following)
Once a day
Once a week
Twice a week
Bi-weekly
Once a month
18 / How often would you like to TWEET messages that say something about you or what you do?
(choose one of the following)
Once a day
Once a week
Twice a week
Bi-weekly
Once a month
PLEASE EXPLAIN ANY OTHER DETAILS OF YOUR BUSINESS THAT WOULD AFFECT HOW WE DESIGN YOUR SOCIAL MEDIA / RADIO INTERFACING. (limit 150 words)
This is our starting point,. We will now work to create a completely interactive package that will bring your business and storefront to the world 24/7. Your integrated media message will soon be part of the total marketing community. Thank you for this opportunity to be part of your success story.
Jessica Northey Mark Margulies

w/ www.fingercandymedia.com w/ www.benmaradio.com
em/ jessicanorthey@gmail.com em/ myinfo@getsocialform.com
ph/ 877/ 751-6667 toll free