Remote Mini Ads Order Form and Questionnaire Step 1 of 333%Remote Mini Ads are designed with a similar process to any full video or advertising production that Modern Icon Media produces. We treat every piece of media as a valuable opportunity to communicate with an audience. The form below may at times feel like a doctor's office form, and that is because it is designed like one. Your business has a pain point, a problem, a challenge, or a goal and we're here to tell your stories to get you where you want to be. Telling those stories starts with knowing a bit more about you, what you do, and why you do it. With this in mind, please try to be as thorough as possible. The introductory call will serve as a tool to further our understanding of the information you fill out here. Please Note: No payment information is taken with your order form. Thank you! -Modern Icon Media Have a question? Email Us: [email protected]Remote Mini Ads Order FormName* First Last Email* Phone*Business Name*Business Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarrussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUS Minor Outlying IslandsUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe Country Website Is your business minority owned?*NoYesPerfer Not To SayWe offer 5% off to minority-owned businesses. This is an honor system, you don't have to provide proof, so we ask you to please be honest.Is this order for a PSA or Non-Profit Organization?*NoYesWe offer 5% off for PSA's, Non-Profit Organizations, and Environmental Conservation/Green Technology companies. Modern Icon Media has final discretion. Proof of non-profit status is required.Pick Your PackageProduct Name*Remote Mini Ad (Base) - $7992 Base Ads Package (5% Off) - $1,5183 Base Ads Package (10% Off) - $2,157Returning Customer's 2nd Base Video Ad (5% off) - $759Please note that any specials, offers, or deals are not reflected here, but will be reflected in your invoice. Multiple video packages will have the overall discount plus their percentage discount.Ad Length*15 Second Ad - Great For Non-Skippable Online Ads30 Second AdAd Length - Ad 2*15 Second Ad - Great For Non-Skippable Online Ads30 Second AdAd Length - Ad 3*15 Second Ad - Great For Non-Skippable Online Ads30 Second AdAd Length - Ad 4*15 Second Ad - Great For Non-Skippable Online Ads30 Second AdAd Length - Ad 5*15 Second Ad - Great For Non-Skippable Online Ads30 Second AdAd Length - Ad 6*15 Second Ad - Great For Non-Skippable Online Ads30 Second AdBasic Add-OnsBasic Optional Add-ons* Use In Radius Greater Than 20 Miles Around Your Business And Unlimited Locations Comcast and General Local TV MPEG Format Spec Delivery Add One Concept Pitch 5 Day Delivery, Requires Call & Review Availability Add Either A 15 Or 30 Second Version Of Your Video Ad Add Square Or Vertical Social Media Edit to Specifically Fit Various Platforms NONEBasic Optional Add-ons - Ad 2* Use In Radius Greater Than 20 Miles Around Your Business And Unlimited Locations Comcast and General Local TV MPEG Format Spec Delivery Add One Concept Pitch 5 Day Delivery, Requires Call & Review Availability Add Either A 15 Or 30 Second Version Of Your Video Ad Add Square Or Vertical Social Media Edit to Specifically Fit Various Platforms NONEBasic Optional Add-ons - Ad 3* Use In Radius Greater Than 20 Miles Around Your Business And Unlimited Locations Comcast and General Local TV MPEG Format Spec Delivery Add One Concept Pitch 5 Day Delivery, Requires Call & Review Availability Add Either A 15 Or 30 Second Version Of Your Video Ad Add Square Or Vertical Social Media Edit to Specifically Fit Various Platforms NONEBasic Optional Add-ons - Ad 4* Use In Radius Greater Than 20 Miles Around Your Business And Unlimited Locations Comcast and General Local TV MPEG Format Spec Delivery Add One Concept Pitch 5 Day Delivery, Requires Call & Review Availability Add Either A 15 Or 30 Second Version Of Your Video Ad Add Square Or Vertical Social Media Edit to Specifically Fit Various Platforms NONEBasic Optional Add-ons - Ad 5* Use In Radius Greater Than 20 Miles Around Your Business And Unlimited Locations Comcast and General Local TV MPEG Format Spec Delivery Add One Concept Pitch 5 Day Delivery, Requires Call & Review Availability Add Either A 15 Or 30 Second Version Of Your Video Ad Add Square Or Vertical Social Media Edit to Specifically Fit Various Platforms NONEBasic Optional Add-ons - Ad 6* Use In Radius Greater Than 20 Miles Around Your Business And Unlimited Locations Comcast and General Local TV MPEG Format Spec Delivery Add One Concept Pitch 5 Day Delivery, Requires Call & Review Availability Add Either A 15 Or 30 Second Version Of Your Video Ad Add Square Or Vertical Social Media Edit to Specifically Fit Various Platforms NONEAdvanced Add-OnsAdvanced Optional Add-ons* Original Video of Your Product(s) (Mailed to Modern Icon Media): +$300-$1000/Filming Day Required. Add Advanced Voice Over: Artist Rate Dependent, Estimated: $100-$400. Actual Business Exterior Drone Footage: Estimated $250-500, Availability depending On Your Location - Coming Soon! Video Ad Campaign Consultation and Copywriting Options +$250-$1000, Depending On Your Budget. Produced Video Concept & Design Copyright License Without Restrictions +$1100 NONEBecause the prices of these options vary based on specific needs, they are not reflected in the estimated total. Please select any you would like included in your order.Advanced Optional Add-ons - Ad 2* Original Video of Your Product(s) (Mailed to Modern Icon Media): +$300-$1000/Filming Day Required. Add Advanced Voice Over: Artist Rate Dependent, Estimated: $100-$400. Actual Business Exterior Drone Footage: Estimated $250-500, Availability depending On Your Location - Coming Soon! Video Ad Campaign Consultation and Copywriting Options +$250-$1000, Depending On Your Budget. Produced Video Concept & Design Copyright License Without Restrictions NONEBecause the prices of these options vary based on specific needs, they are not reflected in the estimated total. Please select any you would like included in your order.Advanced Optional Add-ons - Ad 3* Original Video of Your Product(s) (Mailed to Modern Icon Media): +$300-$1000/Filming Day Required. Add Advanced Voice Over: Artist Rate Dependent, Estimated: $100-$400. Actual Business Exterior Drone Footage: Estimated $250-500, Availability depending On Your Location - Coming Soon! Video Ad Campaign Consultation and Copywriting Options +$250-$1000, Depending On Your Budget. Produced Video Concept & Design Copyright License Without Restrictions NONEBecause the prices of these options vary based on specific needs, they are not reflected in the estimated total. Please select any you would like included in your order.Advanced Optional Add-ons - Ad 4* Original Video of Your Product(s) (Mailed to Modern Icon Media): +$300-$1000/Filming Day Required. Add Advanced Voice Over: Artist Rate Dependent, Estimated: $100-$400. Actual Business Exterior Drone Footage: Estimated $250-500, Availability depending On Your Location - Coming Soon! Video Ad Campaign Consultation and Copywriting Options +$250-$1000, Depending On Your Budget. Produced Video Concept & Design Copyright License Without Restrictions NONEBecause the prices of these options vary based on specific needs, they are not reflected in the estimated total. Please select any you would like included in your order.Advanced Optional Add-ons - Ad 5* Original Video of Your Product(s) (Mailed to Modern Icon Media): +$300-$1000/Filming Day Required. Add Advanced Voice Over: Artist Rate Dependent, Estimated: $100-$400. Actual Business Exterior Drone Footage: Estimated $250-500, Availability depending On Your Location - Coming Soon! Video Ad Campaign Consultation and Copywriting Options +$250-$1000, Depending On Your Budget. Produced Video Concept & Design Copyright License Without Restrictions NONEBecause the prices of these options vary based on specific needs, they are not reflected in the estimated total. Please select any you would like included in your order.Advanced Optional Add-ons - Ad 6* Original Video of Your Product(s) (Mailed to Modern Icon Media): +$300-$1000/Filming Day Required. Add Advanced Voice Over: Artist Rate Dependent, Estimated: $100-$400. Actual Business Exterior Drone Footage: Estimated $250-500, Availability depending On Your Location - Coming Soon! Video Ad Campaign Consultation and Copywriting Options +$250-$1000, Depending On Your Budget. Produced Video Concept & Design Copyright License Without Restrictions NONEBecause the prices of these options vary based on specific needs, they are not reflected in the estimated total. Please select any you would like included in your order.Estimated Sub-Total $0.00 Please Note: Discounts and Advanced Add-Ons Are Not Reflected Here.Minimum Discount: 10%Business InfoBusiness Industry*Business Size*Most Popular Product or Service*Most Popular Special Offer or Sale*Primary Promotion Goal* Special Offer or Sale New Product or Service General Business Awareness RebrandExplain Your Promotion Goal*Most Popular Sale Method*In-PersonOnlineIn App(Other, Explain)Other Most Popular Sale Method ExplainationTell Us A Story About Your Business's Founding*What passions drive your business? Why does you business do what it does? Why do people work for your business?*What is a fun or interesting fact about your business or product?*Ad DetailsPrimary Display Locations For This Video Ad* On Location Your Website YouTube Channel Facebook Page YouTube/Google Ads Facebooks Ads Twitter Ads Instagram Ads TikTok Ads Streaming Service Ads (EX: Hulu) Local Television Comcast Television Other Television Provider Other (Explain)Other Video Display Location ExplainationGeneral Style Goals For The Ad* Formal Feeling (Think Technology Ads, Authoritative Voices ) Informal Feeling (Think Of Most Insurance Ads, Peer Voices) Informational (Think Of Applicance Ads, Educating) Cinematic (Think Of Ads That Feel Like Small Movies, Feeling > Offer) Clearly Feels Like An Ad (Think Of Stores With "Super Sale" Ads)What is the #1 message you hope this video ad conveys to the audience?*What is the #2 message you hope this video ad conveys to the audience?*Audience Details & ResearchAverage Customer Purchase Amount At Your Business & Number of Purchases Per YearWhat is the #1 piece of positive feedback customers give your business?*General Customer Age Range*What brings customers to your business?*What brands of cars do your customers drive?*What brands of clothes do your customers wear?*Any Additional Audience Details You Think Are RelevantAny Other Details You Want Us To Know? (About your business, audience, goals, etc.)Modern Icon Media ResearchHow Did You Hear About Us?* YouTube Google Search Engine Our Website Facebook Twitter Other'Other" How Did You Hear About UsNext Steps: Once you submit this order form, we will be in touch ASAP with an invoice totaling your full bill with discounts and add-ons included. We will work with you to schedule your introductory call after your initial 50% booking payment has been successfully completed. Payments are made via our online payment portal secured through Stripe. Please Note: If you prefer check payment, work will not begin until we have successfully deposited your payment. We look forward to learning about your business and creating something together! Thank you, Trenton Hoshiko, Creative Director Modern Icon MediaCommentsThis field is for validation purposes and should be left unchanged.
