JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Get started with MediaPasifika
Enter your details here
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Organisation
Organisation Name
*
Your answer
Package
*
Options and prices (all prices include gst) based on a 12 month agreement
MediaPasifika for one user — $990
MediaPasifika for two users — $1,490
MediaPasifika for up to five users — $1,990
Other/Not Sure
Billing
*
Payment options based on a 12 month agreement
Annual Payments
Monthly Payments (+15% loading)
Quarterly Payments (+5% loading)
Other/Not Sure
Organisation Size (FTE postions)
*
How many Full Time Equivalent staff are in your organisation
Choose
Individual
2-19
20-49
50-249
250-1,500
1,501-4,000
4,000+
Sector
*
Choose
Business
Public Sector
Community org/charity or social enterprise
PR Agency
Other
Main Contact Person
Contact Name
*
Your answer
Contact Email
*
Your answer
Contact Number
*
Your answer
Next
Clear form
Never submit passwords through Google Forms.
Forms
This form was created inside of Scoop Media.
Report Abuse
Terms of Service
Privacy Policy