Leads – Digital Ad Boards

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?
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?
5. What Industry is your business in?
6. Do you have an AD you would like to use? or do you need us to design one for you?
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.