AE Info

AE Name *

Co Seller

AE Email Address *

Market *

Advertiser Information

Advertiser Business Name *

Contact Name *

Advertiser's Website / URL

Advertiser's Email *

Advertiser's Phone

Advertiser's Business Facebook URL

Campaign Details

Date you need the proposal back by

Campaign duration *

Please Specify Campaign Goals

More Campaign Info

Please note the CTA Destination. (URL Link, Physical Location or Phone Number) *

Percentage of Males: (Demographics)

Percentage of Females: (Demographic)

Household Income Level

Average Sale

Average Customer Lifetime Value

Can we recommend a campaign budget based on the information submitted on this form?

Targeted Audience Location ( City, Zip Codes, Counties, States and/or Radius)

Please specify any requested geo-fencing locations: (If Applicable)

Lifestyle Characteristics, Interests & Behaviors

Other Forms of Marketing Being Used (Currently/Past)

Monthly Campaign Budget

Any other information relevant to this campaign?

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