First Name
Last Name
Email
Phone
Website
Title
Business Name
How did you hear about us?
Type of Business:
Advertising/Marketing
Agriculture
Art/Antiques
Automotive
Clothing
Computers Services
Construction
Education
Entertainment
Furniture/Fittings
Health/Fitness
Home & Garden
Industrial Equipment & Supplies
Jewelry
Legal Services
Manufacturing
Marine/Aviation
Printing
Real Estate
Restaurants/Food/Beverage
Retailer
Safety/Security
Shipping/Moving/Transport
Sports/Recreation
Telecommunications
All Travel
Other
If "other" please explain and/or add category:
Preferred Contact Method
Email is Preferred Phone is Preferred Either is fine - phone or email
Please describe the Goods and/or Services that you would like to offer us on trade for the advertising you desire?
Additional Information about your Target Area(s) (Specific cities, states, regions, countries or other information)
Who are you trying to reach?
Both Consumers and Businesses
Consumers
Businesses
If you are trying to reach Businesses - please describe the types of Businesses and Industries you are trying to reach:
If you are trying to reach Consumers are you trying to reach females, males or both females and males?
Both Males and Females
Male
Female
What age group(s) are you trying to target? (please select all that apply)
18-24 25-34 35-44 45-54 55-64 65+
Other
Median household income of your target market(s) you are trying to reach is: (please check all that apply)
$0 - $25,000 $25,000 - $50,000 $50,000 - $100,000 $100,000 - $250,000 More than $250,000
What are your primary reasons for advertising at this time? (please check all that apply)
Public Awareness/Branding Business Grand Opening Sale/Special Event New Product/Service Launch Direct Response Ads to generate sales leads
Other
Do you currently have an ad agency of record agreement in place?
If yes, with which ad agency?
Will commercial and/or artwork be supplied or do you need commercial/art production?
Art/commercial production needed
Art/commercial will be supplied
What types of advertising are you interested in at this time: (please check all that apply)
TV Print/Magazines Print/Newspapers Radio Sponsorships Billboards Online/Internet Transit (Bus,Airport, Taxi, Subway/Railway) Ad Specialty (custom logo items, premiums/promotions)
What is your media budget?
$
Please tell us what types of advertising have worked for you in the past?
Please tell us what types of advertising have not worked?
Any additional comments or information you would like to add?
