off-line -> on-line question

I've got a couple of ads coming out in a business directory shortly where I make an offer for some free information "($47 value)".

These are little 2" square ads.

I only give a short url in the ad, like "mydomain.com/abc"

Each ad uses a different part after the slash (eg., 'abc' and 'x123') so I can track the response rates from each ad.

The URL is actually just a redirect.

The actual sales page will show an info product with a price of $47.

I want to capture their name and email, but I can do that when they pick up the product. So I don't really need them to land on a "squeeze page". But ... I do need a way to thank them for responding to the ad and tell them how to get the item for free, eg, include a URL or button they need to click that has a discount code included.

I'd also like to have a simple poll where they click one of 5 radio buttons before they continue. (I don't want to share the results with them, tho.)

I'm wondering ... for anybody who's done anything like this -- driving off-line traffic to an on-line offer for a free info product -- what sorts of issues have you run into?

Are there any particular factors I need to focus on?

Anything that works well or things I should definitely avoid?

Thanks
-David