Converg SEM / PPC Campaign Discovery Form

So that we may better assist your goals, please include the necessary information below. If we have any additional questions, we will contact you.

Monthly Budget *
AdWords Customer ID (Please provide if available)

Please enter the child account ID of the AdWords account
Business Name *
Business Phone Number - ### - ### ####
Web Site URL *
Networks you want to be in *
Search Display Youtube Product Listing Ads Facebook Other
If Other Networks (above), please enter it here.
Business Description *

A brief Description. 1 or 2 sentences should suffice.
Geographic Service Coverage Area

Please be descriptive if you focus in a service area by zipcode, city, congressional districts, market DMA, etc...etc..
Expected Activation Date of the Campaign / MM / DD YYYY

If you're requesting this in advance, we can have it built and ready a few days before activation.
Advertising Campaign's Goals *
Products or Services to Focus on *
Promotions, Selling Points, Ad Ideas Discussed
Ad Schedule

Is there a schedule you would like ads to run on? I.e. if you don't answer calls outside of 8AM and 5PM or if it doesn't mater and you want people to go to your website for more information, fill out a contact form, etc.
Primary Keywords *

Keywords for Search. Placements / Topics / Keywords / Interests for Display or YouTube.
Is this a Seasonal Business? If yes, when? *
What's the max cost per Customer acquisition? *

I.e. $90 to acquire a new customer is reasonable
Do you have any Special Offers to Promote? If so, please list them:

10% offer for teeth whitening
Competitors (Please list 2-3 URLs) *
Please list some of your unique selling points: *

24/7 Emergency Service, etc.
Who is your target audience? *

All geners / ages (except kids)
Ad Extension Requirements
Location Extension Phone Extension Sitelinks Extension Social Extension (Google+) Mobile App Extension (Apple or Droid) Other
Please specify address / phone / links / +page / app in the next entry.
If Other Extension from Above, enter it here.
Please provide any additional information that could benefit the campaign here:
Please Fill out the CC Auth form located HERE and re-attach it on this secure form. The networks will be billing you directly.