Phonak Co-op MarketingSupport Request Form Business name* Website address* Full name* Email address* Contact number* Social media handles How many years have you been operating? What areas does your clinic specialise in? Tick the boxes that apply. Rehabilitation Medical Tinnitus Balance Paediatric Other - Please specify Other What type of customers are you servicing? Tick the boxes that apply. Traditional (age related hearing, noise exposure) Tech savvy (interested in the latest hearing aid features) Modern customer (comfortable with technology and remote appointments) Other - please specify Other What sectors are you servicing? Tick the boxes that apply. Private customers Government Mix of both Please provide any additional information.What co-op marketing activity are you seeking support for?What are your objectives for this campaign?Is there a special offer associated with the campaign? For example ‘Free hearing aid trial’.What is the retail value of the special offer?When are you looking to start the campaign?What is the turnaround time for final artwork?If applicable, what are the terms and conditions of the campaign? Please include expiry date and any exclusions. Δ