Kill Order Form: Broadcast, Print, and Programmatic (Already Signed Submission)
Kill Order Date
(Required)
Please indicate the date this Agreement is being created on
MM slash DD slash YYYY
Campaign Kill Date
(Required)
Please indicate the date the Campaign is to be killed 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
Balance Due
(Required)
Please indicate the Total Balance Due for the Advertiser
Name of Advertiser's Business
(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
Contact's Best Phone Number
(Required)
Please include the advertisers best contact Phone Number
Contact's Best Email Address
(Required)
Please include the email for the individual who will be signing on behalf of the Advertiser
Kill Order Details
(Required)
Please provide the details related to the Kill Order
Kill Order Form File Upload
(Required)
Please upload a copy of the signed Kill Order
Drop files here or
Select files
Accepted file types: pdf, Max. file size: 50 MB.