Synergy's New Client Intake Form
Welcome to our New Client Intake Form! Thank you for choosing Synergy Specialty Solutions for your services. We are thrilled that you have chosen to embark on this journey with us. This form is designed to gather essential information about your organization and your specific needs, allowing us to provide you with tailored solutions and a seamless experience. As you fill out the form, we encourage you to provide as much detail as possible. Rest assured that all information you provide will be treated with the utmost confidentiality and used solely for the purpose of serving you better. Once we receive your completed form, our dedicated team will carefully review your responses and reach out to you promptly within 24-48 hours of submission to schedule a consultation. We will work collaboratively to dive deeper into your requirements, clarify any additional information, and discuss the best course of action to address your unique needs.
First Name
Last Name
Email
Phone Number
City and State
Website URL
Organization Name
Please select the answer that best describes your clientele identity.
I am a(n)....
Corporation
Entreprenuer
Nonprofit
Philanthropist
I am not sure
If you are a Nonprofit, have you obtained your 501(c)3 determination status?
Please select one answer
Yes, We have our 501(c)3 tax-exempt status from the IRS
No, We need help obtaining our 501(c)3 tax-exempt status from the IRS
For Nonprofits, please provide your EIN. For others, please enter N/A.
Please provide a brief description of your organization's mission. For Entrepreneurs and Philanthropists, please enter a description of your objectives and goals.
Please select the service(s) that you are interested in:
Social Impact Program Consulting
Experiential Marketing / Event Curation
Organization Establishment (Articles of Incorporation, Bylaws, State Filing)
Nonprofit Incorporation (501(c)3 registration and tax-exempt status)
Impact Measurement and Development
Social Impact Strategy Training
Resource Development For Nonprofits (Individual Giving, Corporate Partnerships, Fundraising Plans)
Grant Writing and Proposal Evaluations (For Nonprofits, Small Businesses, and Corporations)
Campaign Development
Employee Volunteer Engagement Consulting
Program Development
Leadership Training
Board Development and Training
Grant Research
Organizational Strategic Planning and Training
Organizational Budget Development
Digital Marketing Services for Nonprofits
What is your budget for consulting services?
$0 - $2,500
$3,000 - $5,000
$6,000 - $10,000
$11,000 - $15,000
$16,000 - $20,000
$21,000+
Additional Information/Comments
By completing and submitting the intake form, I agree to the terms and conditions set forth, indicating my understanding and acceptance of the guidelines and provisions outlined.
By checking this box, I understand that I will be directed to confirmation page that will lead me to scheduling a 30-minute consultation.
By checking this box, I understand that if I miss my scheduled consultation without notifying the Consultant an additional $50 may be assessed for a new consultation request at the discretion and determination of the Agency.
I would like to subscribe to the SuperConnecters Mailing List.
Submit
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