New Order: Broadcast, Print, and Programmatic (Already Signed) | WSIC

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 Email(Required)

Please indicate your Sales Associate Email

Total 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).

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

Contact's Best Phone Number(Required)

Please include the advertisers best contact Phone Number

Alternative Phone Number

If provided, please include an Alternate Phone Number

Is the Billing Contact the same as above?(Required)

Please indicate whether the Billing Contact is the same as previously provided

Is the Creative Contact the same as above?(Required)

Please indicate whether the Creative Contact is the same as previously provided

Billing Contact Phone Number(Required)

Please include the best phone number for the individual contact for Billing matters.

Billing Contact Email(Required)

Please include the best email for the individual contact for Billing matters.

Creative Contract 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.

Broadcast and/or Digital On-Demand 'Other' Package Term Details(Required)

Please include details related to Broadcast and/or Digital On-Demand 'Other' Package Term

Broadcast and/or Digital On-Demand Campaign Start Date(Required)

Please indicate Advertisers expectations for when the Campaign should begin.

Broadcast and/or Digital On-Demand Campaign End Date(Required)

Please indicate Advertisers expectations for when the Campaign should end.

Radio Commercials Quantity 'Other' Info(Required)

Please include details related to Radio Commercials Quantity 'Other'

Need Help Creating Radio Ads?(Required)

Radio Show Host Details(Required)

Please include any relevant details related to the clients Radio Show Host Campaign

Podcast/On-Demand Details(Required)

Please include any relevant details related to the clients Podcast/On-Demand Campaign

Show Sponsor Details(Required)

Please include any relevant details related to the clients Show Sponsor Campaign

Faith-Based Programming Details(Required)

Please include any relevant details related to the clients Faith-Based Programming Campaign

Broadcast and/or Digital On-Demand Campaign Setup Fee(Required)

Please indicate the One-Time Setup Fee (separate from the Monthly Campaign Fee) for this Campaign

Broadcast and/or Digital On-Demand Campaign Monthly Fee(Required)

Please indicate the Monthly Campaign Fee (separate from the Campaign Setup Fee) for this Campaign

Print 'Other' Package Term Details(Required)

Please include details related to Print 'Other' Package Term

Print 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

Print 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

Is Ad Camera Ready?(Required)

Please indicate whether the advertiser's ad is Camera Ready

Is Advertiser Purchasing Premium Place?(Required)

Please indicate whether the Advertiser is purchasing Premium Placement for their Ad

Premium Placement Fee(Required)

If Advertiser is purchasing Premium Placement, please indicate the additional fee

Print Campaign Design Fee(Required)

Please indicate the total One-Time Design Fee (separate from the Monthly Campaign Fee) for this Campaign

Print Campaign Monthly Fee(Required)

Please indicate the Monthly Campaign Fee (separate from the Campaign Setup Fee) for this Campaign

Programmatic 'Other' Package Term Details(Required)

Please include details related to Programmatic 'Other' Package Term

Programmatic Campaign Monthly Impressions 'Other' Details(Required)

Please include details related to Programmatic 'Other' Campaign Monthly Impressions

Does Advertiser Need Digital Ads Created for Programmatic Campaign?(Required)

Please indicate whether Advertiser needs Digital Ads created for their Programmatic Campaign

Programmatic Start Date(Required)

Please indicate Advertisers expectations for when the Programmatic Campaign should begin.

Programmatic End Date(Required)

Please indicate Advertisers expectations for when the Programmatic Campaign should end.

Programmatic Campaign Setup Fee(Required)

Please indicate the total One-Time Campaign Setup Fee (separate from the Monthly Campaign Fee) for this Campaign

Programmatic Campaign Monthly Fee(Required)

Please indicate the Monthly Campaign Fee (separate from the Campaign Setup Fee) for this Campaign

Electronic Invoice Email Address(Required)

Please include the email we should use when sending Electronic Invoices

Backup Payment Method Selection(Required)

Please select which Backup Payment Method you want us to have on file

Name on Credit Card(Required)

Please provide the Name as shown on the Credit Card

Credit Card Number(Required)

Please provide the Credit Card Number as shown on the Credit Card

Credit Card Expiration Date(Required)

Please provide the Credit Card Expiration Date as shown on the card. Please use the following format: MM/YY

Credit Card CCV(Required)

Please provide the 3 or 4 digital CCV code as shown on the Credit Card

ACH: Name on Account(Required)

Please provide the Name listed on the Account that will be on file

ACH: ABA Routing Number(Required)

Please provide the appropriate ABA routing number for your account

ACH: Bank Account #(Required)

Please provide the Bank Account # for the account

First Month Total Cost(Required)

Please indicate the Total First Month Cost - including all Ad Design & Campaign Setup Fee(s) - for this Campaign including all selected Medium(s) that will be billed on the initial month of the Campaign.

Monthly Campaign Total Cost(Required)

Please indicate the Total Monthly Campaign Fee (separate from the First Month Total) for this Campaign including all selected Medium(s) that will be billed each month after the initial month of the Campaign.

Additional Billing Related Notes(Required)

Please include any additional notes related to the Billing & Payment Information for this Agreement. If none, please indicate with 'None'

Completed Advertising Agreement(Required)

Please upload a .pdf version of the Completed Advertising Agreement.

Drop files here or

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

New Order Form: Broadcast, Print, and Programmatic (Already Signed Submission)