Change Order Form: Broadcast, Print, and Programmatic (For Electronic Signature)
Legal Consent
(Required)
Electronic Signature Consent and Intent to Execute Agreement
This Agreement is entered into between Real Talk Studios, LLC (D.B.A. WSIC) and/or Real Talk Publications, LLC (D.B.A. Lake Norman Woman Magazine, LLC) (collectively referred to as the "Publisher") and the "Advertising Business," including the individual representative signing on behalf of the Advertising Business (collectively referred to as the "Advertiser").
By signing this Agreement electronically, the parties expressly agree and acknowledge the following:
1. Intent to Execute Agreement: It is the intent of the parties to enter into and be bound by this Agreement, and the use of electronic signatures shall serve as evidence of the parties' intent to execute this Agreement.
2. Consent to Electronic Signatures: Both the Publisher and the Advertiser consent to the use of electronic signatures for the purposes of signing and executing this Agreement. An electronic signature includes any electronic sound, symbol, or process attached to or logically associated with a record and executed or adopted by a person with the intent to sign the record.
3. Enforceability: This Agreement, including any counterpart signed electronically, shall be deemed valid, binding, and enforceable under applicable law, including the North Carolina General Statues and other relevant authorities.
4. Representation of Authority: Each party represents and warrants that the individual signing electronically on its behalf has the authority to bind the respective party to the terms of this Agreement.
5. Acknowledgment of Receipt: By signing this Agreement electronically, each party acknowledges receipt of a fully executed copy of the Agreement.
6. Opt-Out Option: Either party may request to execute this Agreement using handwritten signatures. Such a request must be made in writing and communicated to the other party prior to executing the Agreement electronically.
By proceeding with the execution of this Agreement, the parties confirm their intent to be legally bound by its terms and their consent to the use of electronic signatures in determining the validity and enforceability of the Agreement.
I agree to allow Electronic Signatures for this Agreement
Change Order Date
(Required)
Please indicate the date this Change Order is being created on
MM slash DD slash YYYY
Sales Associate
(Required)
Please select the Sales Associate for the Advertiser
Select From Dropdown
Stephanie Sullivan
Michele Schuermann
Diana Brush
Kim Hunter
Patrick Reynolds
Leslie Ogle
Chelsea Bren
Mamie Lee
Justin Ckezepis
Sales Associate Email
(Required)
Please indicate your Sales Associate Email - required for Electronic Signature
Name Of Business Advertising
(Required)
Please include the Business Name of the Advertiser
Advertiser's Individual Contact Name
(Required)
Please include the individual contact for the Advertiser
First
Last
Individual Contact's Phone Number
(Required)
Please include the individual contact for the Advertiser
Individual Contact's Email Address
(Required)
Please include the email for the individual who will be signing on behalf of the Advertiser - required for Electronic Signature
Change Order Details
(Required)
Please include the details of the Change Order
Sales Associate Signature
(Required)
This is the signature field for the Sales Associate
Advertiser's Signature
(Required)
This is the signature field for the Advertiser
Waiting for another signer