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Insertion Order Form Requirements

This document is an insertion order form for advertising services. It collects information about the advertiser such as company name, contact details, and payment details including credit card number and expiration date. The advertiser can choose between three account types - Basic, Pro, and Ultimate - that differ in the number of social media shares or posts provided and corresponding monthly costs. The advertiser's signature is required to authorize the credit card charges according to the chosen insertion schedule and agree to the cancellation policies.

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Anatolii Scutelnic
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© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PDF, TXT or read online on Scribd
327 views1 page

Insertion Order Form Requirements

This document is an insertion order form for advertising services. It collects information about the advertiser such as company name, contact details, and payment details including credit card number and expiration date. The advertiser can choose between three account types - Basic, Pro, and Ultimate - that differ in the number of social media shares or posts provided and corresponding monthly costs. The advertiser's signature is required to authorize the credit card charges according to the chosen insertion schedule and agree to the cancellation policies.

Uploaded by

Anatolii Scutelnic
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd

157 Broad Street, Suite 109, Red Bank, NJ 07701

Phone: (732) 741-2840 Fax: (732) 741-2842


INSERTION ORDER! ! ! ! ! ! Date:_________

Client Account # _______ Insertion # ___________ Sales # ______

Advertiser Information:
Company Name ____________________________________ Contact _________________________
Agency Name ______________________________________ Contact __________________
Address _____________________________ City __________________ State ____ Zip: _________
Phone: _____________________ Fax: ___________________ Email: ________________________

Account Type:
Type PeopleDeals Cost

▢ Basic 1 shareItUp Free

▢ Pro 10 $80 per month

▢ Ultimate 40 $199 per month

TOTAL: __________

Payment Information: ! ! ! ! All payments are to be PREPAID.


Credit Card Number:

Expiration Date: CVC:

Card Type: Visa ▢! MasterCard ▢! AmEx ▢! Other ▢

I understand that my credit card number will be charged in accordance to the above insertion schedule chosen by advertiser. When
a multiple insertion schedule is in effect, your credit card will be charged in a monthly manner and your ad will be picked up from
the previous month. No cancellations will be accepted prior to the “Press Date” or a cancellation fee will apply. No cancellations will
be accepted without written notification. Please note that your below signature is permission for [COMPANY] to periodically
communicate via email & fax.

X _________________________________________________ Date ____________________


Signature (Your signature accepts responsibility of this insertion schedule)
___________________________________________________ Date ____________________
Print
_______________________ ______________________ _____________________________
Phone Fax E-mail

Offer 1! Initials _______ Offer 2! Initials _______

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