Media Buying Request Form

A media buying request template — submit a media buy with the objective, budget, channels, dates and any placement restrictions in one request.

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Description

A media buy is only as good as the request behind it. This media buying request form captures what a buy needs — the objective, budget and channels — so the buying team can plan and place it without going back for the basics.

It captures the campaign title and primary objective, the media budget, and the preferred media channels. It takes the campaign start and end dates, any specific placements or restrictions, and creative guidelines or specs, plus a point of contact.

Use it to submit any media buying request to your team or a media partner. A complete request means the buy is planned around the right objective and budget from the start. Customize the fields, add your branding, and embed it on your site or share a link in minutes.

Form fields

Everything the Media Buying Request Form above collects — 11 fields, so you can see exactly what it captures before you make it your own.

Media Buying Request Form

Campaign Title
Short Answer
What's your primary objective?
Short Answer
Please describe your objective:
Short Answer
Budget Allocation for Media (USD)
Short Answer
Preferred Media Channels
Multi-Select
Campaign Start Date
Date
Campaign End Date (optional)
Date
Any specific media placements or restrictions?
Long Answer
Upload Creative Guidelines or Specs
Short Answer
What's your name?
Name
Best email to reach you on:
Email

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Template FAQs

Common questions about the Media Buying Request Form — what it captures, when to use it, and how to make it your own.

What is a media buying request?

A media buying request is a structured way to ask a buying team to plan and place media — setting out the objective, budget, channels and dates. It gives the buyer what they need to build the buy, rather than working from a rough idea that needs clarifying.

What should a media buying request include?

This form captures the campaign title and primary objective, the media budget, the preferred media channels, the campaign start and end dates, any specific placements or restrictions, creative guidelines or specs, and a point of contact for the buy.

When should you submit a media buying request?

Once the campaign objective and budget are agreed and before the buy needs to run, with time to plan and negotiate placements. Requesting early means the buying team can secure the right inventory at the right price rather than scrambling for last-minute availability.

Who submits a media buying request?

Usually the campaign or account lead, submitting it to the media buying team or a media partner. The form captures who requested it, so the buyer has a clear brief and someone to confirm channel and budget decisions with.

Why capture placement restrictions in the request?

Because brands often have places they won’t appear — certain sites, content or contexts. Capturing restrictions up front means the buyer plans around them from the start, avoiding the risk and embarrassment of a placement that lands the brand somewhere it shouldn’t be.

Is this media buying request template free?

Yes, completely free. Add or remove fields, adjust the channels to fit your buys, and restyle it to your brand, then embed it on your site or share a link — no coding needed. A free Fun Forms account lets you collect requests.

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