Insert Insertion Form

Fill in the requested information below.

Advertiser

Advertiser's Address

Address 1

Address 2

City

State

Postal Code

Country

Contact Person's Name

First

Last

Contact Person's Phone ###-###-####

Contact's E-Mail Address

Ad Agency/Designer

Ad Agency/Designer's Phone Number ###-###-####

Ad Agency/Designer's E-Mail Address

To Be Billed for This Insert (Choose One)

Advertiser

Agency

Title/Subject of Insert

Choose one Note: Insert printing with Color Press must be arranged by the Lake Union Herald managing editor. Printing fees will be passed on from the printer.

Yes, I understand the insert ad fee is $1,000 plus the published rate for display advertising. Printing fees will also be charged if insert is not supplied by advertiser.

No, I am not clear on the fees. Please call to provide additional information.

Order Date

Insertion Issue

Ad design service is available (if desired) for $750 per page.

Ad Design Service (Choose one)

Yes, I will need ad design service

No, I will not need ad design service

Please click Submit after completely filling out form. You may first print out a copy, if desired, using your browser's print feature. Go to "File." Click on "Print" from the drop-down list. Choose your printer and options from a dialogue box.

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