Cutomer Lead Form
1. May I get your First and Last Name?
First
Last
2. What is the best email address for you?
*
Enter Email
Confirm Email
3. Are you advertising a Service, Product or an Event?
Select One
Service
Product
Event
What is the name of your event?
What is the Date of your event?
MM
DD
YYYY
4. Can you tell me what store/location you saw one of our advertising screen?
Select One
Golden Krust (Austell)
Golden Krust (Conyers)
Golden Krust (Douglasville)
Golden Krust (Fairburn Commons)
Golden Krust (Hiram)
Golden Krust (Kennesaw)
Golden Krust (Lawrenceville)
Golden Krust (Marietta)
Golden Krust (Morrow)
Golden Krust (Old National hwy)
Golden Krust (Snellville)
Golden Krust (Stone Crest)
Golden Krust (Stone Mountain)
Fireside (Lithonia/Covington hwy)
Irie Mon Cafe (Peachtree St, Atlanta)
Jamaica Mi Krazy (Smyrna)
Jamrock (Riverdale)
Jamrock (Atlanta/Metropolitan pkwy)
Kool Runnings (Norcross)
Mangos (Auburn Ave)
Sevananda (Moreland Ave. Atlanta)
Sunshine Restaurant (stone mountain)
US1 Package (Decatur)
5. What Industry is your business in?
Select One
Business
Education
Entertainment/Events
Fashion
Finance
Industrial
Internet
Legal
Real Estate
Other
6. Do you have an AD you would like to use? or do you need us to design one for you?
Select One
I have my own AD I want to use.
I would like your company to design our AD
Please list the industry the customers business is in
7. When do you want to start advertising?
MM
DD
YYYY
Customers phone # (write down the phone # from your incoming call list)
*
Additional Notes
Name
This field is for validation purposes and should be left unchanged.
Name
Company
Email
Phone
Plan
Select a Plan
Basic AD Plan
Premium AD Plan
Enterprise AD Plan
State
Message
GET STARTED