Paid Media Intake Form

General
Name **
First Last
Email **
Company Name **
Which countries are you looking to target?
Which states are you looking to target?
Which cities are you looking to target?
Do you have any additional geotargeting comments?
Please list any competitor website URLs.
What do you consider a conversion?
- Make a purchase online
- Attempted purchase
- Other
Please specify other:*
What is the value of your average customer?
How much are you willing to spend to acquire a lead or sale?
Please list any keyword suggestions.
Are there any keywords you do not want us to target?
We will be needing access to the following, please begin to gather login data for:
CMS Google Adwords Google Analytics Google Search Console
Email
This field is for validation purposes and should be left unchanged.

General