Television Input Form

This form allows you to provide users of the Info-Xone with information about your television channel. The InfoXone deals with a large number of enquiries every day, so it is in your interest to be accurate and to keep the information up-to-date.

Please provide the following contact information:

Name of Television Channel:
Owner:
Street Address:
Address (cont.):
City:
State/Province:
Zip/Postal code:
Country:
Work Phone:
FAX:
E-mail:
URL:

Please indicate subject areas covered by your television broadcasts (tick as many as are applicable):

International News	National News	Local News
Comedy	Drama	Financial Matters
Music - Classical	Music - Light	Music - Popular
Sport	Traffic	Women's Issues

Please indicate your primary target audience (tick as many as are applicable):

General Public	Women	Men
Social Classes A, B, C1	Social Classes C2, D & E
Age Group 15-24	Age Group 25-34	Age Group 35-44
Age Group 45-54	Age Group 55-64	Age Group 65 & over

What is the reach of your television channel?

List the names and job titles of the senior staff:
Any other information you would like included:
Any comments to help us:

For quality control and checking purposes, please give:
Name of respondent:
Job Title of Respondent:

Panarc International reserves the right to check, edit or reject any submission.

Last revised: November 15th, 1999