Banner Advertising Account Request Form
*
Contact Name:
*
Email:
Start Date:
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
/
01
02
03
04
05
06
07
08
09
10
11
12
/
2000
2001
2002
2003
2004
2005
(Tip: Use the
Cost Calculator
to help fill out the next three fields.)
*
Pricing Method:
No. of Exposures
No. of Clicks
No. of Days
*
Duration:
(e.g.
10000
Exposures...
2
Clicks...
30
Days)
*
Advert Ranking:
Rank 1
Rank 2
Rank 3
*
Advert Click URL http://
*
Attach Banner Graphic :
*
Preferred Password:
NOTE: Mandatory fields are marked
*