Company Name:
*
Contact Person:
Address
Street Address
*
Address continued
City
*
State
*
Please select...
Please select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District Of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
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Washington
West Virginia
Wisconsin
Wyoming
Puerto Rico
Virgin Island
Northern Mariana Islands
Guam
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Zip
*
Phone:
*
Email:
*
Your company category:
*
Please select...
Restaurants
Bar
Sports
Concerts & Arts
Winter Sports/Events
Financial Institutions
Media
Retail
Other
What sex are you targeting?
*
Male
Female
Both
Target Age:
*
Under 18
18-21
22-29
30-39
Over 40
Socioeconomic Target:
*
Lower Class
Lower Middle Class
Upper Middle Class
Upper Class
What ethnicities are you targeting?
*
African American
Asian
Caucasian
Hispanic
Polynesian
Other
What other ethnicity would you like to target?
Which products do you want to advertise on?
*
Napkins
Coasters
Other
What other product do you want to advertise on?
Length of Campaign in months:
*
Campaign budget:
$0-250
$251-500
$501-1,000
$1,001-2,000
$2,001-4,000
$4,000 or more
Are you interested in adding mobile Marketing or learning more information about mobile marketing?
Yes
No
More Info Please
Are you interested in joint advertising with another company, decreasing your cost but sharing the impressions?
*
Yes
No
Tell Me More
Is there a specific area you'd like to target and would require your ad in?
Yes
No
Please let us know what areas:
What type of venues do you want to advertise in?
Bars
Restaurants
Restaurant with Bar
Concessions
Other
Let us know where else you'd like to see napkins with your ad:
Do you need a graphic artist to create your ad?
*
Yes
No
Tell us a little about the product you are promoting:
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