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First Name*

Last Name*

Project Manager*

Email Address*

Your Company & Division

Name of Promotion*

Name of Brand Being Promoted

KPI / Promotion Objectives*

Campaign Start Date

Campaign End Date

Type of Promotion*

Please provide concepting details / guardrails for our team

Which platform would you like to deploy your promotion on?

Do you require a QR code for your project?*

Does your project require a vanity URL?*

What is your desired vanity URL?

Do you need POS designed?

Do you need POS printed?

Second Form of Entry

Participating States

What are your official rules? Or do you need Optivate Agency to provide these rules?

Will Optivate Agency be purchasing prizes?

Will Optivate Agency be shipping the prizes?

Number of winners?

Prize description

Prize ARV

Media Support

Deadline By Asset (initial proof)

Deadline By Asset (final files)

You selected Other under Media Support. Please input your Other Media Support below.

Media Details

Please list the target DMAs for digital amplification

Design file upload

Accepted file types: jpg, jpeg, png, gif.

Miscellaneous Notes

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