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Business Name: Web Site Address:
First Name: Last Name:
Position Held: Email:
Phone Number (B/H): Phone Number (A/H):
 

Business Address:

     
Street: Suburb:
Post Code: State:

 

Postal Address(if different):

Street Address: Suburb:
Post Code: State:
       

Do you currently advertise on Google and/or Yahoo?


Yes, Google AdWords Yes, Google & Yahoo
No, Not Currently No, Never
       

What Package Would You Like?


Package #1 (Google AdWords) Package #2 (Google, Yahoo,& Bing)
       
What is your monthly budget?   
       
How did you hear about Platinum Clicks?    
       
Comments:
       
       
     





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