Welcome to MediaTrust - The Platform for Performance Marketing

Step One - Contact Information

First Name *

Last Name *

Company

Address *

City *

State/Province *

Country *

Zip Code/Postal Code

Phone *

Secondary Phone

Fax

E-mail *

Retype e-mail *

IM Name

IM Network

Website

Best Day to Call

Best Time to Call (EST)

Referrer's Name or Site

STEP 2 - TRAFFIC INFORMATION

Where did you hear about us? *

How long have you been an affiliate marketer? *

What other Ad Networks do you work with? *

Please provide 1-2 industry references and their contact information *

Include referral / company name / phone number / email

Yearly Revenue with Other Networks *

What is your Yearly Revenue goal with us? *

In what countries do you currently promote offers? *

Please select the top 3 ad categories that are your best performers: *

What offers or campaigns do you typically run? *

How many websites do you own?

What is your approximate monthly visitors?

How many email lists do you run?

What is the average size of each list?

How do you obtain email lists?

Data segmented into demographics?

Traffic Targeting

Other Search Engines

Social Media Networks

What is the metric used to evaluate success?

STEP 3 - Payment Information

Checks Payable to: *

Tax ID:

STEP 4 - Additional Information

Please feel free to add additional information that will assist us in responding to your application:

Terms, Conditions, and the CAN-SPAM Agreement *

By checking the boxes below, I acknowledge that I have read, understood and agree to all Terms and Conditions, and abide by the MediaTrust CAN-SPAM requirements.