Copernic Media Solutions
   

    

Graphic Ad Publisher Information Request Form

All mandatory fields are marked with a (*)

Company Name: *
Contact Name: *
Email: *
Phone: *
Fax
Address1: *
Address2:
City: *
State/Province: *
Zip/Postal Code: *
Country: *
Website URL: *
Category: *

Website's Target Audience:

Please select your website's primary audience: * My site is predominantly Male.
My site is predominantly Female.
My site is frequented by both.
 
Please select your website's primary age group (you may select more than one group): * 8 - 12
13 - 17
18 - 24
25 - 34
35 - 44
45 - 54
55 - 64
65+
Unknown

Traffic Questions:

1. What percentage of your traffic comes from Canada and the US? * %
2. What is your approximate number of monthly impressions? *
3. What is your approximate number of monthly unique users? *
4. What is the average click through rate (CTR) for your site? * %
5. Will Copernic Media Solutions be your main or backup source for ad inventory? *
6. How did you discover Copernic Media Solutions? *

 
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