2026 Order Form (Combined) (For Electronic Signature)
Legal Consent For Use of Electronic Signatures
(Required)
I agree to allow Electronic Signatures for this Agreement
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) (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.
Agreement Date
(Required)
Please indicate the date this Agreement is being created on
MM slash DD slash YYYY
Mediums Included in Campaign
(Required)
Please indicate the Medium(s) included within this package
Broadcasting
Print
Programmatics
Web and Social
Monthly Campaign Rate
(Required)
Please include the Total Monthly Rate (all mediums combined) for the Advertising Campaign. This does not include any Campaign Setup and/or Ad Creation Fee(s).
Sales Associate
(Required)
Please select the Sales Associate for the Advertiser
Sales Associate Selection
Stephanie Sullivan
Paige Vastbinder
Patrick Reynolds
Ellyn Alhemeyer
Tayler Caplen
Brooke McReynolds
Jenn Gatto
Leslie Ogle
Chelsea Bren
Mamie Lee
Justin Ckezepis
Sales Associate Email
(Required)
Please indicate your Sales Associate Email - this is required for eSignature
Name Of Business Advertising
(Required)
Please include the Business Name of the Advertiser
Advertiser Contact Name
(Required)
Please include the individual contact for the Advertiser
First
Last
Advertiser Contact Email Address
(Required)
Please include the email for the individual who will be signing on behalf of the Advertiser - this is required for eSignature
Advertiser's Address
(Required)
Please include the Business Address for the Advertiser. If no physical address, please use the Advertisers Billing Address.
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Advertiser's Phone Number
(Required)
Please include the advertisers best contact Phone Number
Alternative Phone Number
If provided, please include an Alternate Phone Number
Is there a separate Billing Contact?
(Required)
Please indicate whether the Billing Contact is the same as previously provided
Yes or No?
YES
NO
Billing Contact Name
(Required)
Please include the Name of the individual contact for Billing matters.
Billing Contact Phone Number
(Required)
Please include the best phone number for the individual contact for Billing matters.
Billing Contact Email Address
(Required)
Please include the best email for the individual contact for Billing matters.
Is there a separate Creative Contact?
(Required)
Please indicate whether the Creative Contact is the same as previously provided
Yes or No?
YES
NO
Creative Contact Name
(Required)
Please include the Name of the individual contact for Creative matters.
Creative Contact Phone Number
(Required)
Please include the best phone number for the individual contact for Creative matters.
Creative Contact Email Address
(Required)
Please include the best email for the individual contact for Creative matters.
Broadcasting Package Term
(Required)
Please select the Length of the initial Term (Expressed in Months) of the Broadcast and/or Digital On-Demand Campaign
1x
3x
6x
12x
Other
Broadcasting Package Includes
(Required)
Please indicate what is included in the Broadcast and/or Digital On-Demand Package
Radio Commercials
Radio Show Host
Show Sponsor
Podcast/On-Demand Content
Faith Based Programming
Radio Commercials Included in Package
(Required)
Please indicate the quantity of Radio Commercials included within the package
15x per Week
30x per Week
45x per Week
Other
Need Help With Radio Ads?
(Required)
Please indicate whether the Advertiser needs help with creating Radio Ads
Yes or No?
YES
NO
Broadcast Start Date
(Required)
Please indicate Advertisers expectations for when the Campaign should begin.
MM slash DD slash YYYY
Broadcast End Date
(Required)
Please indicate Advertisers expectations for when the Campaign should end.
MM slash DD slash YYYY
Broadcast Setup Fee
(Required)
Please indicate the One-Time Setup Fee (separate from the Monthly Campaign Fee) for this Campaign
Broadcast Monthly Fee
(Required)
Please indicate the Monthly Campaign Fee (separate from the Campaign Setup Fee) for this Campaign
Broadcast Initials
(Required)
If Broadcast and/or Digital On-Demand is included in Campaign, Advertiser must initial here
Waiting for another signer
Print Package Term
(Required)
Please select the Length of the initial Term (Expressed in Months) of the Print Campaign
1x
3x
6x
12x
Other
Print Advertising Size
(Required)
Please select the Print Advertisement size that is to be included with this Campaign
1/8th Page
1/4 Page
1/3rd Page
Half Page
Full Page
2 Page Spread
Special Section Sponsor
Issue Start Date
(Required)
Please indicate the Print Issue first run date. Please select the first day of the month as the day of the month of the Issue
MM slash DD slash YYYY
Issue End Date
(Required)
Please indicate the Print Issue last run date. Please select the last day of the month as the day of the month of the Issue
MM slash DD slash YYYY
Is Advertiser Purchasing Premium Place?
(Required)
Please indicate whether the Advertiser is purchasing Premium Placement for their Ad
Yes or No?
YES
NO
Premium Placement Rate
(Required)
If Advertiser is purchasing Premium Placement, please indicate the additional monthly fee
Print Monthly Rate
(Required)
All Print Campaigns Have A $100 Initial Admin Fee. Please indicate the Monthly Campaign Fee (separate from the Campaign Setup Fee) for this Campaign
Print Initials
(Required)
If Print is included in Campaign, Advertiser must initial here
Waiting for another signer
Programmatic Package Term
(Required)
Please select the Length of the initial Term (Expressed in Months) of the Programmatic Campaign
1x
3x
6x
12x
Other
Programmatic Campaign Impressions
(Required)
Please select the Monthly Total Impressions for the Programmatic Campaign
50,000
100,000
150,000
200,000
Other Impression Amount
Need Help With Creating Programmatic Ad?
(Required)
Please indicate whether Advertiser needs Digital Ads created for their Programmatic Campaign
Yes or No?
Yes
No
Programmatic Start Date
(Required)
Please indicate Advertisers expectations for when the Programmatic Campaign should begin.
MM slash DD slash YYYY
Programmatic End Date
(Required)
Please indicate Advertisers expectations for when the Programmatic Campaign should end.
MM slash DD slash YYYY
Programmatic Setup Fee
(Required)
Please indicate the total One-Time Campaign Setup Fee (separate from the Monthly Campaign Fee) for this Campaign
Programmatic Monthly Fee
(Required)
Please indicate the Monthly Campaign Fee (separate from the Campaign Setup Fee) for this Campaign
Programmatic Initials
(Required)
If Programmatic is included in Campaign, Advertiser must initial here
Waiting for another signer
Web & Social Campaign Includes
(Required)
Please indicate the Web & Social products included within this package
Email Marketing
Website Display Ads
Social Reels
Email Marketing
(Required)
Please select the quantity of Newsletters included within this package
1 Newsletter
2 Newsletters
Live, Work, Play Newsletter
Email Marketing Platform
(Required)
Please select the Newsletter Platform(s) included within this package
WSIC
Lake Norman Woman
Live, Work, Play
Email Marketing Duration
(Required)
Please select the Term of Email Marketing that is included within this package
3 Months (Minimum)
6 Months
12 Months
Newsletter Rate
(Required)
Please indicate the Newsletter Rate for this Campaign
Website Display Ads
(Required)
Please select the quantity of Websites included within this package
1 Website
2 Websites
All 3 Websites
Website Display Platform
(Required)
Please select the quantity of Website Display Platform included within this package
WSIC
Lake Norman Woman
Live, Work, Play LKN
Website Display Duration
(Required)
Please select the Term of Website Display Ads that is included within this package
6 Months (Minimum)
12 Months
Website Display Ad Rate
(Required)
Please indicate the Website Display Ad Rate for this Campaign
Social Reels
(Required)
Please select the type of Social Reels included within this package
Custom Reel
Posting
Social Reel Rate
(Required)
Please indicate the Social Reel Rate for this Campaign
Web Marketing Campaign Start Date
(Required)
Please indicate Advertisers expectations for when the Web Marketing Campaign should begin.
MM slash DD slash YYYY
Web Marketing Campaign End Date
(Required)
Please indicate Advertisers expectations for when the Web Marketing Campaign should end.
MM slash DD slash YYYY
Web Marketing Total Rate
(Required)
Please indicate the Web Marketing Rate for this Campaign
Web & Social Initials
(Required)
If Programmatic is included in Campaign, Advertiser must initial here
Waiting for another signer
Package Notes
(Required)
Please include any additional relevant details related to Billing. If none, please input 'None'
Preferred Payment Method
(Required)
Please indicate your Preferred Payment Method
Credit Card (3.5%)
ACH (No Additional Processing Fees)
Electronic Invoice (Back-Up Method Required)
Back-Up Payment Method Selection
(Required)
Please indicate your Preferred Back-Up Payment Method
CC or ACH?
Credit Card (3.5% Fee)
ACH Payment (No Additional Fees)
Electronic Invoice Email Address
(Required)
Please include the Email Address to where Electronic Invoices can be sent
Invoice Mailing Address
(Required)
Please include a Mailing Address for where we can mail Invoices
Name on Credit Card
(Required)
Please include the Name listed on the Credit Card
Credit Card Billing Zip Code
(Required)
Please include the Billing Zip Code for the Credit Card
Credit Card Number
(Required)
Please include the Credit Card Number
CCV
(Required)
Please include the CCV of the Credit Card
CC EXP Date
(Required)
Please include the EXP Date of the Credit Card in the following format: MM/YY
Name On Account
(Required)
Please indicate the Name as Listed on the Bank Account
Address Listed On Account
(Required)
Please indicate the Address as Listed on the Bank Account
ABA Routing Number
(Required)
Please indicate the Financial Institution's ABA Routing Number
Bank Account Number
(Required)
Please indicate the Bank Account Number
First Month Campaign Rate
(Required)
Please indicate the Total Amount that will be Billed during the First Month of the Campaign
Total Monthly Campaign Rate
(Required)
Please indicate the Total Amount that will be Billed each subsequent Month of the Campaign
WSIC/Lake Norman Woman Sales Associate Signature
(Required)
This is the signature field for the Sales Associate
Advertiser Signature
(Required)
This is the signature field for the Advertiser
Waiting for another signer
