PAY-PER-CLICK (PPC) CUSTOMER INTAKE FORM PLEASE FILL OUT THE FOLLOWING INFORMATION TO GET STARTED WITH YOUR PPC CAMPAIGN. BUSINESS INFORMATIONBusiness Name*Business Address* GENERAL INFORMATION Website URLMonthly Advertising Budget$500-$1000$1000-$2000$2000-$5000$5000-$10000$10000+ GEOGRAPHIC TARGET MARKET Please complete as much of the following information as possible. Target Countries*Target States*Target Cities*Additional GEO Target Comments PRIMARY PRODUCTS & SERVICES1st Priority Product/Service*2nd Priority Product/Service3rd Priority Product/Service PPC CAMPAIGN DIRECTIONWhat type of campaign are you interested in launching?*Paid Search (text ads in search results)Display Ads (banner ads on 3rd Party websites)Both (display & search)Not sureList of Primary Targeted KeywordsCompetitor's WebsitesDo you prefer to run your campaign 24/7?YesNoWhat do you consider a conversion? Which type of conversion is most valuable to you?* We just want traffic Fill out a contact form Phone call Other Make a purchase online Downloads Location Visit What is the value of your average customer?What is the average value of a lead?How much are you willing to spend to acquire a lead or sale? ADWORDS ACCOUNT ACCESS Provide the following information if there is an existing PPC Account you currently manage and/or have access to that you would like us to manage for you.Google Adwords Customer IDUsernamePassword GOOGLE ANALYTICS ACCESS Provide the following information if there is an existing Google Analytics account you currently manage and/or have access to that you would like us to use in conjunction with your PPC account.UsernamePassword CMS / WEBSITE ACCESS URL AddressUsernamePassword REPRESENTATIVE CONTACT INFO Full NamePhone NumberEmail Address This iframe contains the logic required to handle Ajax powered Gravity Forms.