Live Work Play Signup Form | WSIC

Legal Consent For Use of Electronic Signatures(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

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

Business Physical 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 State ZIP Code

Individual Contact Name(Required)

Please include the individual contact for the Advertiser

First Last

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

Location Selection(Required)

Please indicate which Location(s) this Live Work Play Advertisement should be in

Huntersville

Cornelius

Davidson

Mooresville

Troutman

Statesville

Denver

Category Selection(Required)

Please indicate which Category this Live Work Play Advertisement should be placed as

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

Billing Zip Code(Required)

Please include the Billing Zip Code for the card

ZIP Code

Name Listed on Account(Required)

Please indicate the appropriate Name listed on the Bank Account

Address Listed on Account(Required)

Please provide the appropriate Address listed on the Bank Account

Street Address Address Line 2 City State ZIP Code

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

Sales Associate Signature

Advertiser's Signature

Waiting for another signer

General Notes(Required)

Please include any Notes that are relevant to this Advertising Agreement

Live Work Play: Print - Special Section (For Electronic Signature)