| Please
complete ALL fields below: |
| Company
Name |
|
| Web
Site Address |
|
| Daily
Traffic |
|
| Your
Name |
|
| Address |
|
| City |
|
| Zip
Code |
|
| Country |
|
| Email |
|
| Username |
|
| Old
Password |
|
| New
Password |
|
| Targeting |
|
| Site
Rating |
Rating
1 (Children 12 & under)
Rating
2 (General Interest)
Rating
3 (Maybe PG-13)
|
| Send
statistic via email |
Never
Daily
Weekly
Monthly
|
| Send
new leads daily |
No
Yes |
| Notify
me of new leads immediately |
No
Yes |
| Type
of Ads to Display on my site
(DHTML
will not be stopped by popup stoppers
and will maximize your credits)
|
|
| What
Components of leadwhiz would you like to
use?
You can
participate in just component 1, just
component 2, or both at the same time.
Both at the same time will generate free
leads AND double your traffic (See
Further Explanation).
|
Just
Component 1 (6:1 Exchange for Lead
Generation)
Just
Component 2 (Exit Window Exchange)
Both
|
| Allow
voiceover/audio ads on my site
(if you
allow this option, you are entered into
a monthly draw to win 5000 credits)
|
No
Yes |
| Assign
My Credits to |
a specific ad
my account as unassigned credits |
| Choose
Ad here |
|
