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Global Media Marketing, Inc.

3361 E Miraloma Ave

Anaheim, CA 92806

t: 714.792.0213

f: 714-223-1679

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Questionnaire

Global Media Marketing

automotive spot
automotive long form
home/mortgage
Financial
Polecam
Sports
Print Work
Others
Landing Pages

Product/Service Questionnaire

Do you have a product or service that you want to see on TV?

The information you submit will be emailed to you for your records.

We do not sell or lease any email address's.

* are mandatory fields

Name: *

Company name (if applicable):

Phone:

Best time to contact you:

Email: *

We will not share or lease your email address.

Product type: *

Medical

Financial

Automotive

Personal Care

Home and Garden

Personal Electronics

Professional Services

Other

Short description of product: *

Projected selling price of product or service:

Projected shipping price (if any):

On a scale of 1-10, how ready is your product/service for retail: *

1 (Idea in development)

2

3

4

5

6

7

8

9

10 (already packaged, shrink wrapped, priced, and sitting in a warehouse)

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3361 E Miraloma Ave Anaheim, CA 92806
t: 1.888.293.7838 | t: 714.792.0213 | f: 714-223-1679