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Prospect Qualification Form
Submit your Automotive opportunity to the AMM Team to qualify your dealer prospect. This form is designed to check for channel conflicts within each pathway but does not determine whether the prospect is the right fit — that assessment is up to you. The more details you provide, the better we can position you for success with your prospect. Please note: submit one request per rooftop. If you have multiple dealerships, please complete a separate request for each dealer.
AE Name
(Required)
First
Last
AE Email
(Required)
Additional Emails to include
Include any emails of your colleagues to include in communication about this opportunity separated by comma.
Regional Director
(Required)
Please select your Regional Director
Cramer Robinson
Erin Hoffman
JB Ozuna
Jon Bodnar
Josh Oswald
Kurt Laufer
Meghan Glenn
Mike Gross
Rocco Bernardoni
Robert Truman
Tim VanderZwaag
Market – Cramer Robinson
(Required)
Please select your Market
Augusta
Charleston, SC
Charlotte
Greensboro
Greenville, NC
Myrtle Beach
Norfolk
Raleigh
Richmond
Roanoke
Savannah
Spartanburg
Market – Erin Hoffman
(Required)
Please select your Market
Birmingham
Columbus, GA
Dothan
Huntsville
Knoxville
Mobile/Pensacola
Nashville
Panama City
Tri Cities
Market – JB Ozuna
(Required)
Please select your Market
Albuquerque
Billings
Colorado Springs
Denver
Grand Junction
Las Vegas
Phoenix
Salt Lake City
Market – Jon Bodnar
(Required)
Please select your Market
Bismarck
Champaign
Des Moines
Green Bay
LaCrosse
Peoria
Quad Cities
Rockford
Sioux City
Sioux Falls
Market – Josh Oswald
(Required)
Please select your Market
Evansville
Joplin
Kansas City
Oklahoma City
Springfield, MO
St. Louis
Terre Haute
Topeka
Wichita
Market – Kurt Laufer
(Required)
Please select your Market
Tampa
Chicago
Fort Wayne
Grand Rapids
Indianapolis
Lansing
New Haven
New York
Philadelphia
Washington DC
Market – Meghan Glenn
(Required)
Please select your Market
Albany
Binghamton
Buffalo
Burlington
Elmira
Providence
Rochester
Springfield, MA
Syracuse
Utica
Watertown
Market – Mike Gross
(Required)
Please select your Market
Bakersfield
Fresno
Honolulu
Los Angeles
Portland
Sacramento
San Diego
San Francisco
Market – Rocco Bernardoni
(Required)
Please select your Market
Alexandria
Baton Rouge
Fayetteville
Hattiesburg
Jackson, MS
Lafayette, LA
Little Rock
Memphis/Jackson
Monroe
New Orleans
Shreveport
Market – Robert Truman
(Required)
Please select your Market
Abilene
Amarillo
Austin
Brownsville
Dallas
El Paso
Houston
Lubbock
Midland
San Angelo
Tyler
Waco
Wichita Falls
Market – Tim VanderZwaag
(Required)
Please select your Market
Altoona
Bluefield
Charleston, WV
Clarksburg
Cleveland
Columbus, OH
Dayton
Erie
Harrisburg
Lexington
Wheeling
Wilkes Barre
Youngstown
Your Opportunity Details
Dealership Name
(Required)
Include Dealership Name if submitting individual rooftops. If submitting an Auto Group, please include the group name. Please note: if the group has multiple dealerships, please fill out a request for each dealer in addition to the group.
OEM
(Required)
Please select the brand for this dealer
Group
Acura
Alfa Romeo
Aston Martin
Audi
Bentley
BMW/Mini
Ford/Lincoln
GM (Chevrolet/Buick/GMC/Cadillac)
Genesis
Honda
Hyundai
INFINITI
Jaguar Land Rover
Kia
Lexus
Maserati
Mazda
Mercedes-Benz
Mitsubishi
Nissan
Porsche
Rolls Royce
Stellantis (Chrysler/Jeep/Dodge/Ram/Fiat)
Subaru
Toyota
Volvo
Volkswagen
Other
Please identify the dealership brand
Number of Rooftops
(Required)
Please enter a number from
1
to
500
.
If you selected Group, please indicate the number of rooftops.
Is this dealer an active Nexstar client?
(Required)
Are you actively working with this dealer or group and looking to add-on services or is this a brand new client to you?
Please select Active Client or New Client
Yes, Active Client
No, This is a New Client
Previous client, but not active currently
Website
(Required)
Please ensure the dealership’s full website url ONLY is included. No Bing search results, UTM codes, or search codes will be accepted. Accepted format example: https://www.hauserchevrolet.com/
Address
(Required)
Street Address
City
State / Province / Region
ZIP / Postal Code
Anything else you would like to add?
Feel free to drop us a note, concern, or comment as you submit your opportunity for qualification.
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