EXISTING CUSTOMER Advertising Order Form
Rep - Name:
Area:
Brainerd
Little Falls
St Cloud
Princeton
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CUSTOMER INFO
Business Name
DIRECT MAIL AD INFO
Issue / Month
AD Size
Ad Placement
Page Number
Top or Bottom of Pg
Ad Price
PAYMENT INFO
Payment Type        
Card #
Expiration Date
3 Digit CVV Code
Check #
Amt of Check
Cash Amt
Other
Notes: