Mediaworks Landing Page Application Form

Company Name*

First Name*

Last Name*

Contact Number*

Email Address*

Mediaworks Account Manager Email Address*

Are you applying for a GEM website?*

Yes
No

Choose a package tailored to your industry*

Food and Beverage
General Retail
Charity
Services Business

Description of Business

Do you accept the GEM Terms & Conditions?*

Yes
No

We are offering a limited number of free ecommerce websites, for specific industries, for no setup fees and no monthly hosting fees for a 12 month period (from the date of website deployment). The only cost is a 2% monthly Success Fee. The Success Fee is calculated as a percentage of the GST exclusive value of sales made and transactions processed through your website each month.

Following the conclusion of the initial 12-month period (or at any time during the initial 12-month period) you can change your hosting plan to any one of the following:
Basic Hosting – NZ $9.99+GST p/month + 2% Success Fee;
Professional Hosting – NZ $99+GST p/month + 1% Success Fee;
Premium Hosting – NZ $499+GST p/month + 0.5% Success Fee;
Enterprise Hosting – NZ $1,499+GST p/month + 0.15% Success Fee.

If you would like Zeald to undertake additional work for you outside of the standard website package, then we will need to charge for this work. However, we will do everything we can to keep our fees to you as reasonable as possible. You are eligible to apply for a free ecommerce website only if you are in one of the industries that we have a pre-designed and pre-produced website package. To apply for your website, please fill out the form below. We reserve the right to decline your application at our sole discretion and we do not have to disclose our reasons for doing so.

Upload your business logo*

Accepted file types: jpg, png, pdf, Max. file size: 50 MB.

The logo needs to be jpg or png files. Please ensure resolution is as high as possible.

Does this page require a form?*

Yes
No

What fields do you require on your form?

For example: Name, email address, phone number

Enter the URL*

The URL for your landing page will be example.promo.nz. Please enter the keyword you would like to use for your landing page. The keyword will be followed by .promo.nz

Upload any additional images that can be used*

Accepted file types: jpg, png, Max. file size: 50 MB.

Images need to be jpg or png files.
Please ensure resolution is as high as possible.

Upload Primary Image*

Accepted file types: jpg, png, Max. file size: 50 MB.

This is the image that will load at the top of your landing page. It should reflect your business, service or offer. Images need to be jpg or png files.
Please ensure resolution is as high as possible.

Do you require a map on the landing page to highlight your store?*

Yes
No

Enter Your Store Location

Enter Your Store Hours

Provide the Radio Script*

Upload
File URL/Link
Enter Content

Link to your Radio Script

Upload Your Radio Script

Max. file size: 50 MB.

Enter Radio Script Text

Write, Upload, or Provide a link to the content for your landing page*

Upload
File URL/Link
Enter Content

Please note there is no copywriting completed for the Landing Page. We will be using all content provided in this form.

Upload your content files

Max. file size: 50 MB.

File URL/Link

Enter Content

Do you require a video to be displayed?*

Yes
No

File URL/Link

What is the main call to action (What do you want the customer to do?)*

E.g. Sign up for a newsletter, book a consultation, enter a competition. get a quote

Additional Notes or comments