New Campaign Order

Order Date *

Priority *
High Normal Low

Your Name *

Law Firm Name *

Contact Email *

800 number to be advertised (optional)

Law firm website (where can we find your logo?

E-mail(s) that will receive potential client leads *

Do you have a 3rd party intake service(IE: Ice, Lead Alerts, etc)

What type of case? (ex. Hernia Mesh, IVC Filter, Essure)

Describe your ideal client for this campaign?
(ex. Hernia Mesh, Revisions Only, No revisions older than 3 years, run nationwide.)

Do you have any specific Geographic/Demographic targeting that you
would like us to include for this campaign?

Landing Page?
Yes, branded Yes unbranded No landing page needed

Facebook Page?
Yes, branded Yes, new & unbranded Use existing unbranded (no charge)

Daily Budget (Gross)

Total Budget (Gross)