COVID-19 Advertising Support Program (CASP) Application Form

COMPANY INFORMATION
Business Name

Street Address

City

State

Zip Code

Date Business Established

State of Registration or Incorporation

Type of Business Entity
Sole proprietorPartnershipC-Corp or S-CorpLLCNon-profit

Do you verify that your company's status is Active in good standing, and that all necessary operational permits and required licenses are in current standing? If yes, are you prepared to provide copies upon request?
YesNo

Primary Sector of Service
Cultivation Supplies or ServicesManufacture of Cannabis ProductsManufacture of Non-Cannabis ProductsProfessional Service ProviderRetail ServicesDistributorOther

CONTACT INFORMATION
Primary Contact

Title

Contact Phone

Contact Email

FINANCIAL INFORMATION
Estimated Annual Gross Revenue YE-2019

Estimated Q1 2020 Gross Revenue (Jan-March)

Total Annual Direct Advertising Related Expenses for YE-2019

ADVERTISING AND MARKETING INFORMATION
Did your company run B2B advertising campaigns in the 2019 calendar year?
YesNo

Did your company run any B2B advertising campaigns between 1/1/2020 and 3/31/2020? If yes, upon request are you able to provide 'proof of publication' and proof of payment for said services?
YesNo

What B2B advertising medium(s) are utilized by your company? (check all that apply)
Printed publicationsWeb display adsWeb affiliate networksWeb pay-per-clickSocial media platformsPaid promotional contentDirect mailVideoMobileOther

Has the COVID-19 crisis negatively impacted your company's ability to fulfill customer orders?
YesNo

As a direct result of the COVID-19 crisis, has your company's advertising budget changed?
YesNo

In comparison to pre-COVID-19 operations, by what percentage was advertising related expenditures reduced?
No reductionLess than 25% reductionBetween 26% - 50% reductionBetween 51% - 75% reductionGreater than 75% reduction

Does your company rely on B2B advertising platforms to connect business?
YesNoPartially

Would a temporary reduction in advertising-related costs assist your company in these present conditions?
AbsolutelyMaybeNot so much

Would extended payment terms on advertising related expenses assist your company in these present conditions?
YesNo

Provide any other details supportive of your company's need for advertising support:

VERIFICATION OF TERMS

By submitting this application I hereby certify that the information provided is true and accurate to my best knowledge. I understand that any false information may result in a denial of CASP provisions. I understand that this program is intended for companies operating in the cannabis industry and affected by COVID-19 crisis. Our company's wellbeing is dependent on B2B advertising programs to communicate with our customers. Completion of this application does not guarantee any acceptance (or any particular amount) of advertising credit, and understand that CASP does not obligate Inc Media in any manner. Inc Media, in good faith, shall review all applications in a timely manner, and notify approved applicants on a case-by-case basis. Any information provided will be used only for this review process and treated as sensitive in nature, however will not be subject to any confidentiality provisions. All applications are subject to the terms, conditions and polices of Inc Media. Applicant understands eligibility requirements may be changed, modified, or amended by Inc Media, in its sole discretion. Company's representative party must be over the age of 21, and Inc Media reserves the right to verify date of birth. Each applicant agrees to release, discharge and hold harmless Inc Media, and its affiliates, representatives, executives, and employees from any and all claims. Including, without limitation, claims for slander, libel, defamation, violation of rights of privacy, publicity, personality, and/or civil rights, depiction in a false light, intentional or negligent infliction of emotional distress, copyright infringement, and/or any other tort and/or damages arising from or in any way relating to the submission of an application, participation in the selection process, participation in CASP program, the use of any information herein and/or the use of the applicant's name, or other personal information in connection with CASP, or the promotion thereof in all media now known, or hereafter devised. Approved applicants may be required to sign additional documents to this effect.
Applicant understands and acknowledges that no cash of any kind will be provided, and the CASP will only be issued for advertising credits and directly related to Inc Media offerings. The choice of such placement, and media platform is subject to availability. In submitting this application you consent to receive email and electronic communications from us. All rights reserved.

I have read and agree to the above Terms.

I am an authorized representative of the company, and certify that the information provided above is true and accurate.