Publisher Application

* Red fields are required.

Complete and submit the form below to apply to participate in the AlcanceMG Advertising Network.

First Name:
Last Name:
Title:
Company Name:
Address:
City:
State/Province:
Zip Code:
Country:
Phone Number:
Fax Number:
Email Address:
Confirm Email Address:
Website Info
Site Name:
Site URL:

Category 1:
Category 2:
Adserver
Geotargeting
User language

Banner sizes your site accepts:

728*90		300*250
160*600		Interstitials
Pop-Under		Floating banner

Please enter a description of your site:

Payment Information

Payee Name :

Make payment via:
		Enter e-mail
		Confirm e-mail
		Enter Address

Publisher Agreement:

In order to join the AlcanceMG Ad Network, you must enter into a Web Publishers Contract with AlcanceMG. The contract:
Prohibits any content deemed inappropriate by Alcance Media Group at its sole discretion.
Requires that web sites place AlcanceMG ads above the fold on their web pages.
Prohibits the use of robots or any other fraudulent way of generating ad impressions or click-throughs.

I have read and accept the terms and condition of the Web Publisher Contract. Agreement*

Security Code

Publisher Application

* Red fields are required.

Website Info

Banner sizes your site accepts:

Payment Information

Publisher Agreement:

Some of our clients: