Name:
Phone:
Email:
Fax:   

Do you currently advertise online?

     Yes  No

In how many months do you plan on starting your campaign with us?

     1 Month
     2-4 Months
     5-6 Months
     6-8 Months
     9-12 Months

What is your monthly budget for online advertising?

     $0 - $2,000
     $2,000 -$ 5,000
     $5,000 - $10,000
     $10,000 +

Is your present web site participating and any link exchange programs, or "Web rings"?

     Yes   No
   

Do you currently have cooperative online partners?

     Yes   No

If yes, please list.

Are you interested in cooperative advertising/marketing efforts?

     Yes    No

Are you in the internet development or web consulting business?

     Yes    No

Do you have an interest in promoting more than one website with your advertising campaign?

     Yes    No

Do you or does your company represent a number of online clients?

     Yes    No