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Your Contact Details			Our Services: Additional Information (where appropriate please provide as much detail as possible)
Company Name *
Your Name *			1. "Pay per Lead" Sales Enquiries
Your Position *			Volume of extra sales enquiries required (per month)	or Unlimited
Telephone no *			Geographic requirement	National Regional
Email Address *			Other information
Company web address
Company Post Code *			2. Web Site Marketing Campaigns
Your Business			Current volume of visitors to your site (approx per month)
Industry Sector			Desired volume of visitors to your site (per month)
Nature of Business			Available web advertising budget (£ per month)
Current sources of sales enquiries (tick all that apply)	Own Web TV Telemarketing Press Direct Mail Other		Geographic requirement	National Regional
Largest source of enquiries			3. Web Site Consultancy
Current volume of enquiries (per month)			Please describe the issue you need resolved.
Our Services
What services do you require? (tick all that apply)	Pay per lead WS Mktg campaign Web site build WS consultancy		Please sign me up to the Affiniti Newsletter - I'd like to keep in touch with media developments	Yes No

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