PPC Client Intake Form for Advertising Clients

In order to maximize your budget and run the highest quality ads and see the largest return on investment, please provide as much detail as you can

    Company Contact

    * = required

    First Name*

    Last Name*

    Email Address*

    Company Name*

    Company City*

    Company State

    Company Phone Number

    Company Website (If you have one)

    Number of Employees*


    Your Market

    Tell us where you'd like to reach new customers.


    Targeted Country:*

    Targeted States/Provinces:*

    Targeted Cities*

    Targeted City Radius*

    Additional Details Regarding Your Geographic Target


    Your Products/Services

    Tell us the top 3 products/services you'd like to advertise, rank from 1 to 3, 1 being your top priority.

    Product / Services Priority #1*

    Product / Services Priority #2*

    Product / Services Priority #3

    Additional Details


    PPC Campaign Direction


    Which type of campaigns would You like to run?* (Select all that apply)


    Primary targeted keywords / searches*

    When would you like your ads to run?*


    What do you consider to be a website conversion? Which is most important to you?*

    Select all that apply


    Average Value of a New Customer (Monthly)*


    Average Value of a New Lead*


    How much are you willing to spend per lead / conversion?*


    Budget & Start Date


    Initial Project Budget*

    When Are You Looking To Begin?*


    Additional Info?

    Let us know if there's anything else you would like us to know before we contact you back!