Power Play Consulting, LLC
Customer Intake Form

Thanks for taking an interest in our services.  Please fill out the form as completely as possible, (including employee population and types) and we will get back to you as soon as we are able.

*A note about your employees.  Professionals are Owners, Partners, Associates, Counsel, CPA's, CEO's, MD's, etc...  Paraprofessionals are Paralegals, Legal Assistants, Junior Bookkeepers, Medical Techs, Nurses, etc...
First Name
Last Name
Company Name
Address Line 1
Address Line 2
Zip Code
Daytime Phone() -
Contact Cell Phone() -
Fax() -
E-mail Address
Best Time to Contact
Best Method of Contact
# of Professionals
# of Para-Professionals
Total # of Employees
Practice Areas
Additional Comments
How Did You Hear About Us?

Information you send to Power Play Consulting will be held in confidence.
We do not sell our contact lists.