First Name

Last Name

Email

Phone

Agency/ Company Name

OEM Acura Alfa Romeo Audi BMW Buick Cadillac Chevrolet Chrysler Dodge Fiat Ford Genesis GMC Honda Hyundai Infiniti Jaguar Jeep Kia Land Rover Lexus Lincoln Maserati Mazda Mercedes-Benz Mini Mitsubishi Nissan Porsche Ram Subaru Toyota Volkswagen Volvo

Dealership Name

Dealership URL

Desired Campaign Start Date

Budget NBC Spot On A: $1,500 NBC Spot On B: $3,000 NBC Spot On C: $4,500 NBC Spot On Spanish A: $1,500 NBC Spot On Spanish B: $2,000 NBC Spot On Spanish C: $2,500 NBC Spot On + Live Sports A: $3,000 NBC Spot On + Live Sports B: $5,000 NBC Spot On + Live Sports C: $7,500 Custom

Additional Add-On Packages NBC Spot On Spanish A: $1,500 NBC Spot On Spanish B: $2,000 NBC Spot On Spanish C: $2,500 Custom

If custom, please specify package type and budget amount:

Is the dealer enrolling through a certified program? Yes, the dealer is enrolling through Constellation’s certified program. Yes, the dealer is enrolling through another agency’s certified program. No, the dealer is not enrolling through a certified program.

Who should Constellation bill? Constellation should bill the dealer directly. Constellation should bill our agency, and we will bill the dealer.

Should Constellation communicate with the dealer directly? If yes, please provide the dealership contact we should work with.