EmailMe Form - PUBLIC SERVICE ANNOUNCEMENT ORDER

Date Time

MM / DD / YYYY

Account Rep Email

YOUR EMAIL

Name

First Last

Business or Campaign Name

Account Contact

First Last

ENSURE PROPER SPELLING

Phone

### - ### - ####

Contact Email

General Order Instructions

Station

PROOF OF PERFORMANCE REQUESTED?

Number of PSA spots per day

Total number of PSA's per week

Weekly Dollar Value of PSA's

@$13.00 per 30, $26.00 per 60. Multiply by total PSA's per month and put figure here.

Schedule Details

Essay space for traffic to insert orders

Affidavit Times

Yes

No

IF CLIENT DID NOT SPECIFICALLY ASK TO SEE TIMES, CHECK NO.
(this is available to see at any time, after the month, if they ask)

Affidavit Scripts

Yes

No

Copy and Production information

Ad Length

:30

:60

Ads to Rotate

Attachments

MP3 or Copy Document

Web Site if PSA's downloaded

CART CODE(S)

IF KNOWN. IF ROTATION SPECIFY PERCENTAGE NEXT TO CART CODE

Copy

Start Ad

MM / DD / YYYY

Stop Ad

MM / DD / YYYY

Most of the time the same ad runs across the stations with the same flight date. If there are separate ads or flight dates for different stations, please specify start/stop dates in the station order section above under Schedule Instructions.

Rep Signature

Business Type Primary (Product Code)

This is for protection so spot doesn't run next to like businesses

Business Type Secondary (Product Code)

This is for protection so spot doesn't run next to like businesses

Unlisted Business Type(s)

MAKE ABSOLUTELY SURE THERE ISN'T A USEABLE CODE ABOVE. IF YOU USE THIS BLANK, ENSURE J UPDATES THE LISTS WITH THE NEW PROUCT CODE THAT WORKS