So that we can properly begin work on your order, please provide the following contact information:

Which of our packages have you chosen to best suit your current needs?

I would like to consult with a representative. 1 Daily - $132.00/month = $4.25 each 2 Daily - $198.00/month = $3.19 each 4 Daily - $319.92/month = $2.58 each 8 Daily - $445.50/month = $1.79 each 12 Daily - $668.26/month = $1.79 each

Notice: Quoted Rates “Per Month” and include a 15% advance payment discount. Scheduling is “run of schedule” random times, equally divided between all day parts – Morning, Afternoon, Evening and Overnight. Specific times are available at higher rates due to scheduling complications.

Please look over the following free bonuses:

1. Sign-up for 3 months and get 2 additional weeks free.

2. Sign-up for 6 months and get 1 additional month free.

3. Sign-up for 9 months and get 6 additional weeks free.

4. Sign-up for 12 months and get 2 additional months free.

How many months would you like for your messages to run?

One Three Six Nine Twelve More than Twelve

In as many words as you require, what is your idea of the kind of message that you're looking to convey to our listeners?

Do you have any other special preferences that you'd like to discuss with an account executive?

Yes No

At what time would you like to hear from an account executive?

Any convenient time. I will call and setup an appointment. Never 8AM 9AM 10AM 11AM 12PM (Lunch Hour) 1PM 2PM 3PM 4PM After Hours

In as many words as are required, if you have any further special instructions, requests, comments or suggestions, please enter them here:

Please list the "run dates" (dates on which you'd like to start and end) of your message. Also, please list any days and/or times that you would not like for your messages to run:

If you are willing to pre-pay for your advertising, we offer a 15% pre-payment discount. Payment must be received before production commences or you will be billed at regular rates. Will you be taking our special 15% discount for pre-payment?

Yes No