PPC Sign-Up

Interested in Pay-Per-Click services with Kite Media? Fill out the form below to provide us with the information that we need to get started with your business. Please be thorough with the details that you provide.

General Information

This is your personal contact information. It will not be displayed publicly with your ads.

Your Name (required):

Your Email (required):

Your Personal Phone Number:

Your Franchise Number (if applicable):

Business Information

This information may be displayed publicly with your ads or within your website.

Your Business Name:

Business Phone Number/s:

Business Physical Address:

Business Email:

Business Website:

Ad Scheduling:

Products/Services To Advertise:

Specials or Promotions:

Location Targeting

Please list your target cities in order of importance:

Account Information

AdWords Account Login Information

Ad Budget

Ad Text


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