Connectify Networks

Advertiser questionnaire

Company name: *
Website URL: *
Company Category: *

First name: *
Last name: *
Title:
Email: *
Street address: *
City: *
State: *
ZIP: *
Country: *
Day Phone:

Finance contact information	(if same, leave blank)
First name:
Last name:
Title:
Email:
Street address:
City:
State:
ZIP:
Country:
Day Phone:

Primary demographic target:
Campaign run dates:	start: finish:
Data fields for collection:
Domestic / International subscribers:
For International, please list countries:
Payout per lead:
Volume goal:
Monthly budget:

Creative specs for campaign implementation:	88X31 Jpeg logo 50-70 character tagline of offer 250 character description of offer
Data transfer format:
Frequency of data transfer:

* Required information