Online Application

Need help? Contact:
Michelle Roddie
612-798-7203
mroddie@mediarelations.com
Green Screen Web Video Application

Contact Information
Please enter information EXACTLY as it will appear in the video.

Company (legal name)
Contact Name
Title
Address
City
State
Zip
Phone
Ext
Fax
E-Mail
Account Executive
Select the representative you have been dealing with:

Video Shoot Information
Video Shoot Location

Script (Maximum 250 words)


Please Attach Logo:

Pricing And Options
-Green Screen Web Video $795 (price contingent on at least 10 individuals signing up)
Mid-America
Doing business since 1997


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