Welcome to 3C Media Solutions

Advertising Service Request Form

Customer Information

Name:
Email:
Phone:
Community College:
If not a CCC, Business Name:
Is your business 501c3 tax exempt?	Yes No
Address:
City:
State:
Zip:

Request Detail

Description of the Product/Service you would like to advertise:

Requested Advertising Start Date:

End Date:
(You must include an end date in order for the Request to be considered complete).

Length of Spot:
(please indicate minutes or seconds)

Frequency of Run:
(please indicate number of times by day, week or month)

Format of Spot:

Target CCC Audience:
(Who or what groups at the CCC's will be interested in the
product/service you are advertising?)

Target Audience Outside of the CCC System:
(Who or what groups outside of the CCCs will be interested
in the product/service you are advertising?)

Other Information/Special Requests:

We reserve the right to discontinue the advertising at any time.

PRIVACY

3C Media Solutions is funded by a grant from the Chancellor’s Office, California Community Colleges. 3C Media Solutions is the satellite
delivery system for distance education, training and meeting collaboration, linking the 109 campuses of the California Community Colleges System.
© 2007 California Community Colleges Satellite Network (CCCSAT). All rights reserved.