Client Info :
For Week of :
Company Name :
Agent Name :
Company Address :
City :
State :
Zip :
Phone# :
Fax# :
eMail :
Insertion Information and Ad Size
1/4
1/2
Full
Vertical
Horizontal
New
Pick-Up
Pick-Up w/Changes
Issue Last Ran :
Which Page :
Price :
Length Of Run :
Notes?
Materials will be sent to RIM Advertising by means of :
Email
Mail/Carrier
Other
