Name *

First Name

Last Name

Company Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

What are your needs at this point in time? (Please check all that apply.) *

Brand strategy

Entity naming

Identity development

Product Development

Copywriting/content strategy

Illustration

Website design & development

Packaging design

Merchandise design

Environmental/store design (includes signage)

Print collateral (business cards, letterhead, etc.)

Marketing & PR

Social media strategy

Wholesale strategy

E-Commerce strategy

Brand partnerships

Other

When would you ideally like to receive a proposal from Potency? *

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DD

YYYY