Insertion Order Form

mission statement

circulation

insertion order

advertising rate card

subscriptions

editorial calendar

general conditions

insertion order form

Customer Information

*advertiser ::

*contact ::

*address ::

*city ::

*state ::

*zip ::

*country ::

*phone ::

fax ::

*e-mail ::

Agency Information

ad agency ::

contact ::

address ::

city ::

state ::

zip ::

country ::

phone ::

fax ::

e-mail ::

Ad Specifications

*issue date ::

*ad caption ::

*ad size ::

*color ::

*covers ::

special
requests ::

Product Information

art enclosed ::

*arrival date ::

pick up from ::

special
requests ::

Invoicing Information

*frequency ::

*gross cost ::

agency fee ::

*net cost ::

*authorization ::

Date:

*accepted by ::

Date:

Payment by Fax

Please fill out all forms and fax credit card information along with this page to Automotive Leadership at: (734) 418-2356.

Card Type ::

Card Number ::

Security Code ::

Name on Card ::

Expiration Date ::