Video Ad Intake Form

Name*

First Last

Title*

Email*

Business Name*

Phone*

Business Category*

Business Type*

Business Address*

Street Address Address Line 2 City State ZIP Code

Business Phone*

Website URL*

Upload your business logo image(s).

Drop files here or

What product/service would you like to promote?*

What discount or special offer do you want to promote for the above product/service?*

For example: 25% off photo shoot for first time customers. A savings of $50. Please be sure to specify the actual % discount and the $ savings.

Name at least two Benefits of your product/service? (What problem does it solve for your customer?)*

What are your color preferences? Please mention 2 colors of your choice:*

Please write your mission statement or company slogan, if you have one:*

When people see your video ad, what would you want them to do? Please check all that apply.*

Upload any image(s) you would like to be used in the Video Ad.

Drop files here or

Name

This field is for validation purposes and should be left unchanged.