Form Sending Pay-Per-Click (PPC) Data to www.nilsem.com Rockford, IL

First Webs, Inc.

Rockford; Chicago; the World

Form for Submitting Pay-Per-Click (PPC) Information
Use this form to send basic information for a PPC campaign; Titles in red indicate required field

Your Full Name

eMail Address

Phone i.e. (xxx-yyy-zzzz)

URL of Your Company, i.e. www.xyz.com

Description of Your Business (250 characters MAX):

URLs of Main Competitors

Admin Contact for Your Company

What is an average gross sales transaction for you? What is your profit margin?

This information is very important is determining advertising costs. We treat it strictly Confidential. It helps us evaluate your ROI.
Avg. Gross Sale	Avg. Profit Margin, %

Which Search Engines Do You Wish to Use?

Google

Yahoo! Search

Ask

Do You Wish to Set-up Locally or for the entire US?

Locally

Nationally

If You Said Locally, then fill in both boxes at left.

Locally means within a certain distance of your business, or near major MSA (Metropolitan Statistical Areas).

How far is the driving range one way from your business home? (the business radius)
What major cities around your business home do you wish to target? List 1 per line.

List the top 3 keywords or phrases first - one per line only. Then list others beneath the top 3 and separate them by commas.

This box is for words or phrases that prospects would use to find your business on the Internet:

My total monthly budget is $:

Enter a 2 digit number minimum

If you selected multiple engines, then provide the approx % budget for each engine.

Google	Yahoo! Search	Ask Jeeves
Each value must be 3 places between 0 and 100. 20% would be 020; 0% would be 000; 100% would be 100

The page for the ad

When people see your ad online, and they click on it, what page do you want them to go to. Enter don't know if you aren't sure.

Other Comments

Thank you for providing accurate, objective information. The information helps us better serve you.

7431 East State Street, #236

Rockford, IL 61108

815.332.8062

vwwanner@nilsem.com

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