BannerSpace.com, Internet Advertising Solutions.

Publisher Application

General Information
Site Name:
URL:
Password:
Daily Traffic:	(page impressions per day)
Referred By:	Enter numeric ID of publisher. (leave blank if you were not referred by an existing publisher)
Contacts
Sales Contact:
Email:
Phone:
Fax:
Traffic Contact:	Same as Sales
Email:
Phone:
Targeting
Category:
Geo-Targeting:	Check here if you can geo-target. This applies if the users of your site are primarily from a defined geographic region, or you can target based on user entered criteria. Zip code for geo-target Miles from (if target area is limited)
Where payments are sent
Important: This is exactly what prints on your payment check.
Name:
Street:
City:
State:
Zip:
Country:
Tax Id.:	(if individual use SS#)
I have read and agree to the publisher Terms.