Please complete & submit this form and a
P/S/T
representative will contact you soon.
First Name:
Last Name:
Company:
Title:
Email Address:
Category:
Select One
Brand / Sponsor
Public Relations
Advertising Agency
Direct Mail Agency
Service Company
Packaged Goods
Other
Address:
City, State & Zip Code:
AL
AK
AZ
AR
CA
CO
CT
DE
DC
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
Phone:
How did you hear about
P/S/T
?
Select One
Existing Client
Former Client
Google Search
Promo Magazine
Referral
If referral, by who?
If Google search, keywords used?
Please provide some background information about this promotion:
Name of Sponsor:
Tentative promotion name:
This promotion is a:
Select One
Sweepstakes
Contest
Game
Fulfillment
Other
If other, please describe:
Target audience:
Select One
Consumer
Trade
Level of US participation:
Select One
National
Regional
Local
Check below if this promotion will be offered in any of these states:
Florida
New York
Rhode Island
Will this promotion be offered internationally?
Yes
No
If yes, please indicate:
Canada excluding Quebec
Canada including Quebec
Other country
Other countries:
How will this promotion be advertised?
TV
Print Ad
FSI
POS
Direct Mail
Web
Other, please describe:
Promotion start/end dates:
Entry Mechanics - briefly explain how consumers participate:
Are minor eligible to participate?
Yes
No
Minimum age of eligibility:
Tentative Prize Structure:
Qty:
Prize Level
:
Description
:
Retail Value:
Grand Prize
First Prize
Second Prize
Third Prize
Fourth Prize
Fifth Prize
Will the total prize value exceed $5,000?
Yes
No
Is
P/S/T
handling merchandise fulfillment?
Yes
No
Is
P/S/T
handling trip fulfillment?
Yes
No
Type of estimate needed:
Rough Numbers (verbal or email)
Tight Numbers (formal agreement)
Estimate needed by (date/time):
To whom should this estimate be directed:
General Request
Specific
P/S/T
employee name:
