Name

Job title

Daytime phone

Fax

E-mail address

Company

Street address

City  State  Zip Code

Web site address

Describe the product or service that your business offers
and what you will be advertising (be specific).

  No Yes Have you purchased radio airtime in the last 12 months?

If so, please indicate the city and/or station(s) call letters.

Yes No Has your commercial been produced yet?

Yes No Do you have a broadcast copy of your commercial?

Length of your commercial (multiple selections OK)
30 seconds  60 seconds

City (or cities) in which you want your ad to air

Beginning airdate

Ending airdate

Day(s) of the week you want to be on the air
  Weekdays Weekends
  Mon.  Tues.  Weds.  Thurs.  Fri.  Sat.  Sun.           

Time(s) of day you want to be on the air

Radio station format(s) you're interested in.

List any specific station(s) you would like us to pursue ad rates from.

-- Select One -- $5,000 - $10,000 $10,000 - 15,000 $15,000 - $20,000 $20,000 - $25,000 $25,000 - $30,000 $30,000 - $35,000 $35,000 - $40,000 $40,000 - $45,000 $45,000 - $50,000 $50,000+ What is your monthly radio ad budget?

-- Select One -- Google MSN Yahoo! Other search engine Asset Marketing Systems New Idea Media Referred by own company Referred by a friend or colleague Other (Please specify) How did you hear about I Buy Time?

Important: Based on the information you've provided above, please use the field below to describe what your expectations are in terms of results from advertising on the radio.

*I Buy Time reserves the right to refuse service to anyone, particularly to those whom, in our judgment, are unsuitable for our services based on the information submitted.