Beamed Media Activation Form

Client Advisor *

Business Name *

First Name *

Last Name *

Street Address *

Address Line 2

City *

State *

Zip Code *

Phone Number *

Email Address *

Package Type *

Monthly Amount *

First Payment * +

Text/Loyalty Program *

Zenreach- * Only applies to Digital Ad Clients- We’ll optimize the performance of the ads by funneling them into the best channel and audiences. Contract Terms: 3-months This is an agreement and expires on *Per the terms of your agreement, your Local Ads subscription will auto-renew. An early termination fee (equivalent to two months of your local ads subscription) is required should you choose to terminate your contract before contract expiration. * There is a 25% Management Fee that is taken out of your Agreed Ad Spend Up Front. *

Multi Location- Addtional Locations ( Please List Name'Address/Contact Info *

Review Responding? *

Please Include All Contacts Who Will Be Receiving Negative Review Notifications *

Social Posting *

Choose your onboarding date * +

Access to Social Media Profiles and Online Review Pages will be collected during your Onboarding Call. Note that your billing will begin Two weeks from the submission of this form. *

Name on Card *

Credit Card Type *

Credit Card Number *

Expiration Date (mm/yy) *

Security Code *