Date:-
Platinum Database Pre qualification form
Customer Information
Company Name
Contact Person Name
Email
Address
City
Postal Code
Country
Telephone
Mobile
Media Vehicle
In-Bound Marketing
Out-Bound Marketing
eMarketing
facebook
twitter
LinkedIn
delicious
tweetmeme
Blogs
RSS
stumble
youtube
myspace
slideshare
SMS
MMS
Email
Fax
Snail Mail
GSM Modem
Bluetooth
Shortcode
IVR
iSurvey
eNewsletter
eBanner
Xplore
Cell Media
eCRM
eCMS
SEO
eWAP
DS GradeStat
Sales Genie
Azoogle
Wordpress
SMS Details
Message Language
Arabic
English
French
German
Message wordcount (characters)
70
160
70+
160+
SMS Count
1
2
3
4
Message Type
Songs
Ringtone
Text
Unicode
Message Text
Sender ID
Characters
Sender ID Language
Arabic
English
French
German
Database Details
Specs
Client Test Numbers
Dataslices Test Numbers
Client Database
Dataslices Databank Count
Qualtity
Server Log ID (Internal use only)
SMPP IP
201.153.9.1
201.153.9.2
201.153.9.3
201.153.9.4
SMS Gateway No
B3A4
A7A4
E3W9
M4X3
Email Details
Html/Text Language
Arabic
English
French
German
Landing Page
Active
Non Active
Landing Address
Approved By
Approved By (Internal Use Only)
Municipality
Chabmer of Commerce
W3C
Media Authority
Other
Website Analytics
Yahoo
Heatmap
Google
Double Click
Web Stat
Webtrend
iWebclick
Other
Campaign Reasons
Branding
Sales Increase
General Information
Drive traffic to URL
Promotions
Invitation
Alerts
Other
TimeStamp:(GMT+4)(Optional)
Hour
08:00
09:00
10:00
11:00
12:00
13:00
14:00
15:00
16:00
17:00
18:00
19:00
20:00
21:00
Start
Hour
09:00
10:00
11:00
12:00
13:00
14:00
15:00
16:00
17:00
18:00
19:00
20:00
21:00
22:00
End
Execution Date
January
February
March
April
May
June
July
August
September
October
November
December
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
World Region
Countries
Cities
USA
New York
Texas
Washington
California
Florida
New Jersey
Pennyslvania
Others / All
CANADA
Ottawa
Ontario
Quebec
Halifax
Victoria
New Brunswick
Edmonton
Others / All
UK
London
Birmingham
Manchester
Oxford
Cambridge
Lanchester
Westminster
Others / All
GERMANY
Berlin
Hamburg
Munich
Heidelberg
Bielefeld
Rothenberg
Bremen
Others / All
ITALY
Roma
Perugia
Milano
Venezia
Napoli
Bologna
Cagliari
Others / All
FRANCE
Paris
Lyon
Marsielle
Lille
Toulouse
Nice
Bordeaux
Others / All
AUSTRALIA
Sydney
Melbourne
Brisbane
Perth
Adelaide
Newcastle
Canberra
Others / All
NEW ZEALAND
Wellington
Hamilton
Queenstown
Christchurch
Auckland
Dunedin
Cambridge
Others / All
JAPAN
Tokyo
Yokohoma
Osaka
Nagoya
Sapporo
Kobe
Kyoto
Others / All
CHINA
Beijing
Shangai
Hongkong
Tianjin
Wuhan
Shenzhen
Nanjing
Others / All
S.KOREA
Soul
Inchon
Kwangju
Pusan
Taegu
Taejon
Busan
Others / All
UAE
Abu Dhabi
Dubai
Sharjah
RAK
Fujeirah
UAQ
Al Ain
Others / All
KSA
Riyadh
Jeddah
Mecca
Madina
Damman
Ta'if
Tabuk
Others / All
KUWAIT
Kuwait City
Abdullah Al Salem
Al Andalus
Bayan
Bneid Al-Qar
Al Da'iya
Al Dasma
Others / All
BAHRAIN
Manama
Muharraq
Riffa
Hamad Town
Budaiya
Jidhafs
Adliya
Others / All
QATAR
Doha
Al Ghanim
Al Khor
Abu Thaylah
Al Jasrah
Dukhan
Al Mafjar
Others / All
OMAN
Muscat
Nizwa
Ruwi
Salalah
Sur
Ibra
Saham
Others / All
EGYPT
Cairo
Dairut
Beni Hasan
Aswan
Ismailia
Damanhur
Abu Qirqas
Others / All
LEBENON
Beirut
Ra's Bayrut
Tripoli
Sidon
Tyre
habbouch
Joinie
Others / All
Database Attributes
GENDER
AGE / YEAR
INCOME (AED)
ETHNIC GROUP
Male
13 - 15
16 - 19
20 - 24
0 - 5000K
5001 - 10K
10001 - 15K
15001 - 20K
Arab / ME
European
American
Australian
Female
25 - 29
30 - 39
40+
20001 - 25K
25001 - 30K
30001 - 35K
35K+
African
Indian Sub
Asian
Others / All
Name
:
Dataslices Authority
:
Signature
:
Signature
:
Terms & Conditions :
For multi campaigns, seperate forms need to be filled .If web analytics is not implemented Dataslices can provide the same with extra charge .80% Gurranted Reach .Minimum 10 Days are required to submit full report