Todays Date:
Account Executive's Name:
Cell Phone Number:
Zone/s:
Billing Terms:
$
monthly per zone/s.
Material Enclosed(check all that apply):
Brochures
Photo/Negs
Disk
Ad's
Other
Ad Type:
New
Redesign
Ad Type:
Front Cover
Back Cover
2pg Spread
Full Page
1/3
2/3
D_card
Classified
Internet Only
Glossy:
Yes
No
Info For Ad:
Co. Name:
Phone No/s:
Address/s:
Client Contact for art dept:
Name:
Cell:
Email:
Background Color Preference:
Font Preference:
Style Preference:
Coupon/Offer:
% Off
$
Off
Item:
Exclusions:
Coupon/Offer:
% Off
$
Off
Item:
Exclusions:
Coupon/Offer:
% Off
$
Off
Item:
Exclusions:
Coupon/Offer:
% Off
$
Off
Item:
Exclusions:
Headline:
Additional Information: