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Last Name:
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Company Name:
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Email Address:
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Phone:
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Company URL:
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Type of Business:
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Internet Retailer
Online Publisher
Direct Marketer
Interactive Agency
Other
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How many customer
records (both existing
and prospects) are
in your
database?:
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0 - 5,000 Names
5,000 - 25,000 Names
25,000 - 50,000 Names
50,000 - 125,000 Names
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How many customers
do you currently
serve?
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How can Topica
help you?
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Acquire new prospects and sales leads
Convert leads into customers
Grow customer value thru repeat business
All of the above - Acquire, Convert, Grow
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to receive from us?
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Customized proposal
Free solution consultation
Product demonstration
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How soon will you
need help with your
marketing objectives?
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Immediately (0-30 days)
30-90 days
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Industry Newsletter
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Topica Discussion List
Topica Partner
Trade Show/Event/Conference
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