WRITERS’ Journal
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If you require assistance in
completing this order form, please call: 218-346-7921.
Please FAX this form to: 218-346-7924 or mail it to: Val-Tech Media, P.O. Box
394, Perham, MN 56573
Date: ____________________
Space in WRITERS’ Journal is hereby ordered subject to conditions stated below.
Advertiser
Name: ___________________________________________________________________
Address:__________________________________________________________________
City: __________________________________ State: _________ Zip: ______________
Contact: _______________________________ Phone: ___________________________
Fax: ___________________________
Web site:________________________________ E-mail:____________________________
Agency/Accounting
(If applicable)Name: ___________________________________________________________________
Address:__________________________________________________________________
City: __________________________________ State: _________ Zip: ______________
Contact: _______________________________ Phone: ___________________________
Fax: ___________________________
Web site: _______________________________ E-mail: ___________________________
For advertising guidelines, ad requirements, closing dates, and terms and
conditions please see our online media kit at: http://www.writersjournal.com/newonlinemediakit.htm.
(Circle): J/F M/A M/J J/A S/O N/DIssues
Rate Frequency (Circle):
1 Time 3
Times 6 Times
Ad Size (Circle):
Full Page Half Page (horizontal)
Half Page (vertical)
Quarter Page Eighth Page
Specialty Advertising/Insert
Position (Circle
if applicable):
Rate:
Please see our rate card, or visit: WRITERS' Journal Online Media Kit for our detailed ad rates. If you have been quoted an ad rate, please state the name of the ad representative. We allow the standard 15% commission to recognized ad agencies.Rate:
_____________________________________________________________________________________________________________________________________________
***FIRST-TIME CUSTOMERS: YOUR FIRST INSERTION MUST BE PAID IN ADVANCE***
To pay by check:
Print out this form and mail it with your check, payable to:
Val-Tech Media
PO Box 394
Perham, MN 56573
Card Number______________________________________ Expiration Date:___________
Name: ___________________________________________________________________
Address:__________________________________________________________________
City: __________________________________ State: _________ Zip: _______________
FAX to: 218-346-7924
Or mail to: Val-Tech Media, PO Box 394, Perham, MN 56573
Thank you! A WRITERS’ Journal representative will contact you to confirm your order.
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