Restricted Drug Term Personalization Certification Application

Please select the product you are applying for *

Select a Google Ads Customer ID *

If you are an agency or someone who manages multiple Google Ads accounts, please do not enter the Customer ID for your Google Ads Manager Account. Please select the Customer ID for the individual account. Learn how to find your Google Ads customer ID.

DV360 Advertiser ID *

Please limit each form submission to a single DV360 Advertiser ID.

Your DV360 Advertiser ID seems invalid. Please try again.

Contact name *

Contact email *

Please use a valid email id of the format example@abc.com

Account Login Email ID

Please provide a phone number we can call to reach you

Keep in mind: We'll do our best to call you, but we still might email you if that's the quickest way to give you help.

Email CC

Add additional field

Include an email address you would like to CC on this submission. Click the "Add additional" link to add multiple email addresses.

End Customer Company Name *

What is the name of the company being advertised? If you belong to an agency, please provide the name of the company that you’re managing the campaigns for. This will help us route your case to the best available agent.

Websites *

Add additional field

List the domain(s) to which your ads will redirect.

Are you an agency applying on behalf of an advertiser? *

If you are an agency, please attach a letter from the advertiser authorizing you to apply on their behalf. We will accept only one format of this letter, a template of which can be found here.

Upload file *

Upload letter from the advertiser authorizing you to apply on their behalf.

Restricted Drug Terms Personalization Terms and Conditions Agreement
Please check the boxes below if, on behalf of your company, you agree that you have read, understood, and agreed to the following advertising terms, and you are duly authorized to accept them: *

*

I confirm that the information (i.e., customer lists, websites and advertisements) involved in this certification complies with all relevant regulations, including, but not limited to, any state, federal, provincial and self-regulatory compliance. Google does not provide any compliance or legal guidance for advertisers. Advertisers need to consult with their own legal and compliance teams before using Google's products and services to address all of their questions or concerns. *

Restricted Drug Term Personalization Certification Application

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