Live Work Play Signed | WSIC | Local Starts Here

Agreement Date(Required)

Please indicate the date this Agreement is being created on

Sales Associate(Required)

Please select the Sales Associate for the Advertiser

Sales Associate's 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

Contact's Best Email Address(Required)

Please include the email for the individual who will be signing on behalf of the Advertiser - this is required for eSignature

Contact's Best Phone #(Required)

Please include the advertisers best contact Phone Number

Alternative Phone #

If provided, please include an Alternate Phone Number

Payment Method(Required)

Please select the Payment Option you prefer for us to have on file for your Campaign

Name on Card(Required)

Please include the Name as it appears on the Credit Card

Credit Card Number(Required)

Please include the full Credit Card Number

Expiration Date(Required)

Please include the Expiration Date of the Credit Card. Please format as MM/YY

CCV(Required)

Please include the 3 or 4 digit CCV code shown on the card

Name Listed on Account(Required)

Please indicate the appropriate Name listed on the Bank Account

Account #(Required)

Please include the Bank Account # that should be used for the ACH Bank Draft

ABA Routing #(Required)

Please included your bank's ABA Routing #

Campaign 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

Campaign 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

Monthly Campaign Total $(Required)

Please indicate the Total Monthly Campaign Fee for this Campaign including all selected Locations that will be billed each month. This DOES NOT include any Add-Ons

General Notes(Required)

Please include any Notes that are relevant to this Advertising Agreement

Please upload the Signed Agreement for this new Live Work Play order.(Required)

Accepted file types: pdf, Max. file size: 50 MB.

Live Work Play: Print - Special Section (Already Signed)