Google Ads Basic Package Form Google Ads Basic Package Step 1 of 3 33% Name* First Last Email* Phone Number* Do you currently have an existing regular AdWords campaign?* Yes No Please provide your Google Adwords Customer ID number below. When you log in to your Adwords account, you will find this number in the top right hand corner. See the image below to see exactly where this number is located. If you do not have a Google Adwords account, you must create one before moving forward. Click here to learn how & to create one. Google Ads Customer ID #*Note: The customer ID # is NOT the email address you use for your Adwords account. Please enter a number in the field below. Is there a credit card linked to your regular Google Adwords account? If not, before submitting this form, make sure your Google Adwords account is linked to a credit card & set to auto payments. This ensures we can get your Adwords campaign up and running as quickly as possible. Billing Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Website URL* Phone Number For Your Practice*City where your practice is located. (Note: Default settings include a 20-mile radius around your city, or a 40-mile radius around small towns)* Many times, the unique characteristics and specific location of your office can help personalize your ad, and attract a specific population. With that being said, please describe your office location. Are there specific characteristics or attractive qualities of your location we should know about? For example, are you near a main public transit line? Are you near a university campus or close to downtown offices? Is your location in a well known neighborhood? Please note that as well as the cities and/or zip codes you would like this ad to appear in here.Additional Location Information*Does your location have a recognizable abbreviation that could appear in the ad, for example SF for San Francisco? Do You Take Insurance?* Yes No Do you see clients in the evenings and/or on weekends? The specialty that you want promoted & the corresponding URL to your specialty page*NOTE: You must have a corresponding specialty page URL for the specialty you list below. Please include the specialty and the URL below. Monthly budget*We suggest $10/day or $300/month for medium competition cities & $15-18/day or $450-540/month for high competition cities. Describe your personal style*Are you serious, academic, gentle, cool, reserved, intuitive, New Age or other? How many years experience of practicing do you have? What are your academic credentials? Most often, these things can be gleaned from your website, but we like to hear it straight from you, in order to personalize your ad.Affinity is a huge factor in choosing a therapistAre you gay, Christian, Jewish, Black, Asian, Latino, etc.? Are you fluent in another language? Do you offer counseling in that language? Are you currently in the process of building a new website?*If so, please note that your Google Ads work will commence upon completion of your new site. This is due to a number of factors, such as correct URLs corresponding to landing pages. Yes No Enter anything here that you would like us to know about setting up your account (for example, any specific areas/populations you'd like us to focus your ad on or concerns you may have).Please enter the characters you see below to submit the form.Please enter the characters you see below to submit the form.