Insertion Order

Name

First

Last

Email

Legal Company Name

Phone

DBA if Used

Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Advertisment Space Requested

Refer to Media Kit Product, Category, and Size

Advertisment Duration Requested

Refer to Media Kit Product, Category, and Size

Link Digital Ad to:

URL or Video link

Total Fees Agreed

Add total of requested advertisments

Payment Schedule

100% of first month is required for all placements. Multiple months will be invoiced

Authorized Signature

Clear Signature

Must be authorized by listed company to sign.

Print Name

First

Last

Used Ad Email

Ad Start Date

Ad End Date