myluckyzone.com

Company Registration

Name of your organization or company *

Name of contact person *

Contact email *

Confirm email *

Password *

Confirm password *

Contact phone *

Contact fax

Address line 1 *

Address line 2

City *

State *

Zip / Postal code *

Country *

What does your company do? *

Would you like to offer your products to myluckyzone.com for additional publicity?
No Yes

Website Type *

What are your product lines?

any other product lines?

What title do you want users to see for your advert or website? *

What is the URL for your website? *

If you have more than one url for the same advert or website please list them

Give a short description of your company or website *

What amount do you want to invest for this advert? * (amount in $)

What maximum seconds do you want each user to spend on your web page per session? Must be greater than 20 *

How many times do you want to allow same user to see your advert in a month? *

Were you referred to or contacted by someone? *
Yes No
Please provide name of who contacted you:

Please provide your website logo in jpg or png format