Host a Screen – Kwik Local Ads

Section 1 — Business Info

Business Name

Contact Person

Email Address

Phone Number

Website / Social Link

(optional)

Preferred Contact Time

Morning
Afternoon
Evening
Anytime

Address

Address Line 1

City

State / Province / Region

Postal Code

Country

Section 2 — Venue Details

Type of Business

Other

Approximate Customer Foot Traffic

Hours Open to the Public

ie. Mon-Fri 9 to 5

Section 3 — Technical Requirements

Do you have reliable Wi-Fi?

Yes
No

Do you have a TV or display with an available HDMI port?

Yes
No

TV must connect to the Internet

port? Other check

Preferred TV Location

e.g., front counter, waiting area, lounge

TV Size (approx.)

Section 4 — Hosting Agreement Acknowledgement

Please check

I confirm my business has Wi-Fi or an available HDMI port.

Please check

I understand hosting includes local ad content .

Please check

I have read and agree to the Host Terms & Requirements.

Section 5 — Optional Notes / Uploads

Additional Comments

(optional)

File Upload

Drag & Drop Files, Choose Files to Upload You can upload up to 3 files.

Upload a Photo of Your TV Area (optional)

How did you hear about us?

(optional)

Section 1 — Business Info

Section 2 — Venue Details

Section 3 — Technical Requirements

Section 4 — Hosting Agreement Acknowledgement

Section 5 — Optional Notes / Uploads

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