Ad insertion order and sales contract

Ad insertion order and sales contract

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AD INSERTION ORDER & SALES CONTRACT:

Please print clearly:
Issue Date(s): _________________________ Frequency: ______________________________
Ad Description: _______________________________________________________________
Ad Size: ________________________ Ad Placement: _________________________________
Special Features (color, etc.): _____________________________________________________
Standard Rate (per ad): ______________________
Frequency Discount: ________________________

Adjustments: ______________________________

Extra Charge (s): ___________________________

NET PRICE (per ad): _______________________

Authorized Signature of Company Representative _____________________________________
Date ______________

BILLING ADDRESS (Please send Invoice to):

CORP. NAME: ______________________________________________________________

ATTN: _____________________________________________________________________

ADDRESS: _________________________________________________________________
_________________________________________________________________

PHONE: ( )_________________________ FAX: ( )__________________________

E-MAIL: ___________________________________________________________________

Note: This document must be signed and returned to the NFB Diabetes Action Network before an ad can be accepted for publication.

Mail form to:
Voice of the Diabetic
1412 I-70 Drive SW, Suite C
Columbia, MO 85203
Fax: (573) 875-8902

Questions contact:
Eileen Rivera Ley
National Advertising Editor
Phone: (410) 296-7760

Posted: January 22, 2002