Advertising Insertion Order Form
Insertion Order Form Instructions:
  1. "Fill in all of the fields." Please provide as much information as possible to ensure proper ad placement.
  2. "Print" the form (before submitting)to FAX and for your own records. (Use the "Print" button at the bottom of this page)
  3. "Submit" the form after printing.
  4. "Sign The Printed Form"
  5. "Fax the Signed Form" to 847-577-0129
 
Ad to be placed in
Publication
Client Information
Address
City
State
Postal Code
Telephone
(include area)
Fax
(include area)
Contact Name
Advertising Agency Information
Agency
Address
City
State
Postal Code
Telephone
(include area)
Fax
(include area)
Ad Information
Size & Color Information
Width (in inches)
Height (in inches)
Ad Placement Vertical      Horizontal 
Color
Other Color
Additional Ad Information
Ad Gross Total $.00
Ad Date(s)
Ad to Run "From"
Month Day   
Ad to Run "To"
Month Day   
New Materials will arrive by
Month Day   
P/U ad that ran
Month Day   
Authorization & Compliance Agreement
I Agree     I Do Not Agree 
Date
All rates, billing procedures, mechanical requirements per current rate card apply.
Authorized Signature

________________________________
Sign before Faxing to 847-577-0129