* 1. Please fill out the information below

* 2. Please provide your website URLs below
(Please type in at least one website URL below)

* 3. Position Held

* 4. Describe your ideal target market

* 5. Do you have an in-house mailing list right now?

* 6. Types of Web Promotion Channels you have tried before

  Check the ones you have tried before
Email Marketing
Pay-Per-Click Advertising
Banner Advertising
Newsletter Advertising
Interstitial Advertising
Co-Registration List Building
Social Media Promotions
Article Marketing
Video Marketing
Organic Search Engine Optimization
Traffic Exchange Programs
Affiliate Sales Team
Offline Advertorials
Postcards / Direct Mail
Magazines / Journals
None Of The Above

* 8. What is the average conversion for this product or lead page? [Example: 0.5%, 1%, 2%, 3%...etc]

(Please leave this field blank if you have NOT tested this product yourself.)

* 10. Do you have any special requests or questions that needs clarification when we speak with you?

(Please type in your request below)