Media Plan Request Form
Please be aware that one business days is our turnaround time for media plan requests.
Station and Market *
Please specify your station and market
Your answer
Orbit Sales Representative *
Banner CPM (to client) *
Please specify client CPM rate
Your answer
Account Executive Name *
Your answer
Email Address *
To enter multiple addresses please place a semicolon ( ; ) in between addresses
Your answer
Client Name *
Will also be the Campaign name.
Your answer
Client URL *
Your answer
Estimated Interest Level *
Not So Much
Closed Deal
Campaign Start Date *
MM
/
DD
/
YYYY
Campaign End Date *
MM
/
DD
/
YYYY
Monthly Budget (no symbols or commas) *
Your answer
Geography *
The geolocation of the campaign (country, region/state, city, metro code/zip code)
Your answer
Target Audience and Secondary Audience *
Demo, location, any specifics
Your answer
Who is the biggest competitor (URL)? *
Your answer
Objective of the campaign? *
Your answer
Overall Notes/Meeting Summary *
Your answer
Does the client currently have an active Adwords campaign?
If so what is the budget of the AdWords campaign?
Your answer
Recommendations of programs to utilize *
Check all that apply
Required
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