Advertising Request Form

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General Business Ad Request Form

This Ad Request Form is meant for Escort Agencies, Massage Parlours, Strip Clubs, Adult Video Stores and any other similar type business.
If you are an individual provider, please use the Individual Provider form.
If you are an employee of an Existing Advertised Business on Erotic Canada, please use the Staff member Ad Request form.

Please continue to the form below.....
You will be contacted asap regarding your new ad.

** = Required fields - All other info is completely optional

Please allow 48 hours after you submit this form for your request to be processed.
A sample ad will be created and a link will be sent to you to proof read and approve.
Further details regarding ad information, photos and payment will be discussed at that time.
Ads must be prepaid before being added to Erotic Canada.

** = Required fields
All other info is completely optional
** Category:
Location(s) your Business is located (and areas you visit if applicable)
** City and Province:
Primary Street Address:
(If you have a "walk-in" location)
Contact Info
** Your name:
(Only used by the Admin to contact you about ad setup)
** Contact E-Mail:
(Required to verify ad copy before it's posted)
** Please Confirm
E-Mail:
(Re-Enter as above to ensure accuracy)
Ad Info
** Business Name:
(Name that will be displayed in ad)
Business E-Mail:
(E-Mail that will be displayed in ad - Optional)
Phone:
(Number that will be displayed in ad)
Website URL http://:
(If applicable)
Rates:



Hours Serviced:



Services Provided:



Greeting to display in ad:
Private messages to the Erotic Canada Administrator regarding this ad
Questions or Comments:

If a current advertiser here referred you to this site please type the advertiser's name here:

Please allow 48 hours after you submit this form for your request to be processed.
Your ad will be created and a link will be sent to you to proof read and approve your ad.
Further details regarding ad information, photos and payment will be discussed at that time.
Ads must be prepayed before being added to Erotic Canada.