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US Marketing Representative Application
Website URL
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First Name
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Last Name
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Company Name
Address 1
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Address 2
City
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State
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ZIP code
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Phone Number
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Fax Number
E-mail Address
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Website Categories
(choose up to 3 categories):
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Personal Home Page
Arts
Business
Education
Entertainment
Family
Home & Living
Mature/Adult
News
Regional
Science
Shopping
Society & Culture
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Other
Briefly describe your website
Website Stats & Demographics
Monthly Unique Visitors
Fewer than 500
500 to 5,000
5,000 to 50,000
50,000 to 500,000
over 500,000
Monthly Page Views
Fewer than 500
500 to 5,000
5,000 to 50,000
50,000 to 500,000
over 500,000
Visitor Age
Under 18
18 - 26
27 - 50
Over 50
Visitor Gender
Mostly Female
Mostly Male
Both
Does your website require a login?
Yes
No
Does your website offer rewards/compensation?
Yes
No
Does your website donate a portion of proceeds to an organization?
Yes
No
Do you manage more than one website?
Yes
No
QuickCare Pet Insurance Programs are underwritten in the U.S.A. by Praetorian Insurance Company, administered by PTZ Insurance Agency, (& “Brokers”) Ltd. Coverage is not available in AK. QuickCare Pet Insurance Programs are underwritten in Canada by Lombard General Insurance Company of Canada, distributed by PTZ Insurance Brokers Ltd. & Gestion GroupAssurance inc. in Quebec. Coverage is available to all residents in all provinces, excluding the territories. PTZ et al is a wholly owned subsidiary of Pethealth Inc. © 2004 Pethealth Inc. All right reserved. All images are the sole property of Pethealth Inc., and are not to be reproduced without permission.
