Advertising Order Form
Name: _____________________________________________________________________________
Business Name: ____________________________________________________________________
Business Address: __________________________________________________________________
Type of Business: __________________________________________________________________
Years In Business:_______________________ Tax I.D. No.:______________________________
Phone: _____________________ Cell ________________________ Fax: _____________________
Web Address: ______________________________________________________________________
Email Address: _____________________________________________________________________
Target Customers: _________________________________________________________________
Referred by or Sales Person’s Name _________________________________________________
Ad Type
Place Ad on Which Site:
Total Cost
Placement: Advertising placement is considered “run of site” unless otherwise specified above.
Right of Refusal: Any camera-ready artwork submitted by advertiser or advertising agency representing the aforementioned client, is subject to approval. Any advertising found to be not appropriate or meeting community standards of decency will be refused.
Agencies: Recognized advertising agencies will receive 15% commission with the submission of camera-ready artwork and payment of the account within 30 days of invoice.
I warrant and represent that the information above is true, and that I am not prevented from entering this agreement with ACCUDAQ, LLC by any legal or other restrictions.
The above named company and authorized representative hereby authorizes the following advertising campaign and agrees to the terms. Payment: All advertising insertions are due prior to performance. Remit payment via check or money order to ACCUDAQ, LLC, 14781 Memorial Dr. #559, Houston TX 77079. For payment via credit card, call our Houston office at 281-438-7500.
Signature: _______________________________________________________ Date:_____________
