General InformationCompany NameContact Name First Last Address Street Address City State / Province / Region ZIP / Postal Code PhoneFaxEmail Advertising DetailsAd Order I will be providing print ready artwork. Please enter my new ad per the following instructions:Ad Duration 1 Quarter 2 Quarters 3 Quarters 4 QuartersAd SizeRate per issueSelect OneMarketplace Small | $100Marketplace Large | $1601/8 Page | $2001/3 Page | $4001/4 Page | $3001/2 Page | $500Full Page | $600Centerspread | $1,650Inside Front Cover | $1,125Inside Back Cover | $1,025Back Cover | $1,225Ad SizeRate per issueSelect OneMarketplace Small | $125Marketplace Large | $1851/8 Page | $2501/3 Page | $4501/4 Page | $3501/2 Page | $550Full Page | $750Inside Front Cover | $1,225Inside Back Cover | $1,125Back Cover | $ 1,325Ad SizeRate per issueSelect One1/8 Page | $2501/3 Page | $5251/4 Page | $4251/2 Page | $625Full Page | $825Inside Front Cover | $1,525Inside Back Cover | $1,425Back Cover | $1,625Ad Orientation Horizontal Vertical No PreferenceThis field is hidden when viewing the formMultiplierThis field is hidden when viewing the form4x TotalThis field is hidden when viewing the form2/3x TotalThis field is hidden when viewing the form1x TotalTotal Amount DueNotesAccount ManagerMolly RidenhourWendy HornePayment TermsInvoices will be issued individually unless client prefers to pay for the full year. Payment for invoices is due upon receipt. Invoices not paid by the due date will incur interest at the rate of 3% per month. I have read and understand the terms of this advertising agreement. I understand that I am obligated to pay for the space for the length of the agreement. All accounts are required to pay 100% of the first month’s insertion upon signing the advertising agreement.Signature (use mouse or touchpad)TitleDate MM slash DD slash YYYY PaymentDavieLiFE magazine issues invoices electronically using a software called Freshbooks. Your invoice will come directly to your email inbox and the sender will be listed as Sum5 Communications (Freshbooks may also be listed in the incoming email).* Please note that your card will NOT be charged automatically when you submit this form. Any notes will be passed along to your Account Manager prior to billing.Name on Credit CardCredit Card NumberExpiration DateCVV Code Please mail a paper copy of my invoice instead.
