First Name*
Last Name*
Email*
Phone
Website
Title
Business Name*
Type of Business:
Advertising/Marketing
Business Services
Computers and Technology
Consumer Products and Services
Entertainment/Recreation
Food Services
Home and Garden
Industrial Equipment and Supplies
Real Estate
Transportation
Travel
Other - if other please specify
Other
Preferred Contact Method
Email is Preferred
Phone is Preferred
Either is fine - phone or email
Define Your Target Market
Target Area(s) you are trying to reach at this time:(check all that apply)
Local
Regional
National
International
Don't know at this time
Additional information about your target area(s) (i.e. specific cities, states, regions, countries, or other information)
Who are you trying to reach?
Consumers
Businesses
Both Consumers and Businesses
Don't know at this time
If you are trying to reach Consumers, gender is primarily:
Male
Female
Both Male and Female
Don't know at this time
What age group(s) are you trying to target? (check all that apply)
18-24
25-34
35-44
45-54
55-64
65+
Don't know at this time
If you are trying to reach Consumers, median household income is: (check all that apply)
$0-$25,000
$25,000 - $50,000
$50,000 - $100,000
$100,000 - $250,000
More than $250,000
Don't know at this time
If you are trying to reach Businesses - please describe the types of Businesses and Industries you are trying to reach:
What are the annual sales of the Businesses you are trying to reach? (check all that apply)
$0 - $100,000
$100,000 - $500,000
$500,000 - $1,000,000
$1,000,000 - $5,000,000
$5,000,000 - $10,000,000
over $10,000,000
Don't know at this time
Outline Your Objectives
What are your primary reasons for advertising at this time? (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 - if other please specify
Additional information/comments about your advertising objectives:
Do you currently have an ad agency of record agreement?
Yes
No
If yes, with which ad agency?
Will commercial and/or artwork be supplied or do you need commercial art production?
Art/commercial will be supplied
Art/commercial production needed
What types of advertising are you interested in at this time: (check all that apply)
Print – Magazines
Print – Newspapers
Radio
TV
Sponsorships
Online/Internet
Outdoor
Transit (Bus, Airport, Taxi, Subway/Railway)
Ad Specialty (custom logo items, premiums/promotions)
Unsure at this time
Other - if other please specify
What is your current media budget?
$
Don't know at this time
When would you like to start? (leave blank if your start date is flexible)
When would you like to finish? (leave blank if your end date is flexible)
Any additional comments or information you would like to add: