Agency Database Registration

If you would like to provide us with information about your agency for consideration in future agency searches please complete the form below. There is no charge for doing so, and your information will be automatically entered in our database.

If you have been invited to complete this registration for a specific review, please provide your agency’s information for the office in consideration only. You may be asked for addition detail at a later point.

Contact Information
Agency Name*	Phone Number*	() -
Contact First Name*	Fax Number	() -
Contact Last Name*	Cell Phone	() -
Title*	Email Address
Address Line 1*	2^nd Contact
Address Line 2	2^nd Contact Title
City*	2^nd Contact Phone	() -
State*	Agency Website
Zip*	Year Founded
	Other Locations

Type
Full	Creative	Fullfillment/Facilities Mgmt
Direct	Collateral	Pop
YP	CRM	Promotions
PR	Interactive	Other
Media	Co-Op	Other

Account Mixture
Under $5 Million	%
$5 - $10 Million	%
$10 - $20 Million	%
$20 - $50 Million	%
$50 - $100 Million	%
Over $100 Million	%

Agency Industry Experience
Retail	Communications
Consumer Goods	Consumer Durables
Industrial Products	Entertainment
Hospitality	Financial Services
Automotive	Government/Defense
Healthcare	Transportation
High Technology	Other
Metals/Base Materials
Non-Profits
Pharmaceuticals

Ethnic Focus
Hispanic	African American	Other

Billing
Enter amount in millions
2008 Billings:
2009 Billings:
2010 Billings:

Media Distribution
TV	National	%
	Cable	%
	Spot	%
Radio	National	%
Radio	Spot	%
Print	Newspaper	%
	Consumer Magazine	%
	Business/Trade Magazine	%
Other	Out of Home	%
	Interactive	%
	Direct Mail	%
	Other Media Expenditure	%

Participation in Recent Searches
Year of Search	Account	Credentials	Finalist	Winner	Consultant

Ten Largest Clients
Client Name	AOR	Year Became Client	Gross $ Billings	OR	% of Total Agency Billings
					%
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					%
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					%

Current Staffing (# of employees)
Executive Management
Account Management
Creative
Traffic and/or Production
Media
Research and/or Planning
Technology and/or Interactive
Other

Total # Employees Per Year
2008:
2009:
2010:

Agency Ownership or Network