O R D E R  F O R M

Please reserve the following advertising space size as checked/selected below:

MONTH
WEEK OF INSERTION & # OF INSERTS
TOTAL INSERTS
January 2007
WEEK 1
WEEK 2
WEEK 3
WEEK 4
WEEK 5
February 2007
WEEK 1
WEEK 2
WEEK 3
WEEK 4
WEEK 5
March 2007
WEEK 1
WEEK 2
WEEK 3
WEEK 4
WEEK 5
April 2007
WEEK 1
WEEK 2
WEEK 3
WEEK 4
WEEK 5
May 2007
WEEK 1
WEEK 2
WEEK 3
WEEK 4
WEEK 5
June 2007
WEEK 1
WEEK 2
WEEK 3
WEEK 4
WEEK 5
July 2007
WEEK 1
WEEK 2
WEEK 3
WEEK 4
WEEK 5
August 2007
WEEK 1
WEEK 2
WEEK 3
WEEK 4
WEEK 5
September 2007
WEEK 1
WEEK 2
WEEK 3
WEEK 4
WEEK 5
October 2007
WEEK 1
WEEK 2
WEEK 3
WEEK 4
WEEK 5
November 2007
WEEK 1
WEEK 2
WEEK 3
WEEK 4
WEEK 5
December 2007
WEEK 1
WEEK 2
WEEK 3
WEEK 4
WEEK 5

NOTE: Issue days are Mondays, Wednesdays, and Fridays,
except for holidays (New Year's Day and Christmas)

Total # of Insertions (6 to 150):

Total Cost (in USD):

Payment type:
 Please Invoice
Payment is on the way

Choose Ad size:
468 x 60 pixels
210 x 130 pixels
225 x 320 pixels

  • Production materials: Ads can be accepted in GIF or JPEG format under 12k in size with a maximum animation limit of 3 loops. Please provide hyper-linking URL with your insertion order.
  • Payment & Cancellation terms: Payment in full for the contract period must be prepaid. No cancellations are accepted during the contract period. Advertiser indemnifies the publisher from any and all liability for content of advertisement and company website. The publisher reserves the right to reject or discontinue any advertising or any part thereof.

Ad is being submitted via email

Link ad to (insert website link):

AUTHORIZED BY:

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Title:
Company:
Address1:
Address2:
City:
State:
Zip:
Country:
Daytime phone:
Daytime fax:
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