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FPC MAGAZINE

PRINT ADVERTISING

INSERTION ORDER FORM

Advertiser Contact Info:

ADVERTISER NAME/COMPANY

First and Last Name

Advertiser Contact Email

Advertiser Phone

Billing Address

A copy of the magazine is sent to the billing address. If you'd like a copy of the magazine sent to one additional person each time invoices are mailed out, please provide their name and address below.

Send Invoices to:

Advertiser

Agency

E-mail invoices to:

AGENCY NAME (IF APPLICABLE)

Agency Contact Email

Agency Phone

Agency Billing Address

AD ORDER

Advertising Year

Our rates are based on size, color, and frequency.

Please note: Our rates are based on frequency with price breaks at 3, 6, 9, and 12 times. If your order falls between any of those, your pricing will default to the higher rate (i.e. 4x run will be figured at the 3x rate on the rates and specs page of the media kit.) Rates are per insertion.

OPTIONAL:

Prepay annual

Prepay monthly

COLOR CHOICE

FULL COLOR (4C)

SPOT COLOR (2C)

B & W

PAID POSITION (PAGE) REQUEST

NOTES:

Signature

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