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* 1. What is your first and last name?

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* 2. What is your email?

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* 3. What is your company's name?

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* 4. What industry are you in?

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* 5. What is your company's website URL (if any)?

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* 7. How many employees does your business have?

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* 8. What BlueVine products do you use?

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* 9. How satisfied are you with BlueVine?

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* 10. Would you be willing to have your company featured in a customer testimonial case study for BlueVine’s blog or website? If you say yes, we'll follow up with more information.

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* 11. Would you be willing to talk to a reporter about your experience with BlueVine? If you say yes, we'll follow up with more information.

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* 12. What’s the most interesting thing about your company? (Some potential examples: We’ve quadrupled in size in the last 6 months; everyone told us we were crazy to think this could be a business; my mom started this family business in a male dominated field)

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