To present advertising opportunities to our Media Buyer

Your Name

Email

Phone

Publication Name

Url of your Publication

Your Company Name

Your Sales Authority- -(What is your relationship to the ad publisher?)

In House Sales Rep Agent with Exclusive Rights Independent Media Broker Other-please describe in comments

Media Type-
-(Magazine, web advertising, etc)

Circulation-
-please include all information--like subsciber copeis, newsstand copies, viewed imporessions etc)

Verified?-
-(if yes-by whom?)

Comments: What are you selling? -(Print ads: include size or section information. Web ads: include urls of live web ad samples for evaluation)