Event Radio TV
 
 
Note : All Fields marked with * are compulsory
 
   PERIODICAL AND MAGAZINE MEDIA FORM
   Name first     last
   Address
   City
   State
   Zip Code
   Email Address
   Telephone No.
   Fax No.
   Date Established DD      MMM       YYYY
   Federal I.D. Number
   Owner First       last
   Chief Editor First       last
   Advertising Manager First       last
   Size

½ Page      ¼ Page      Full Page

   Type of File
   Address Creative shuold be emailed to
 
   Coverage area
   Person to Contact First       last
   Frequency Weekly       Daily
   Closing Date DD      MMM       YYYY
   Cancellation Date DD      MMM       YYYY
   Number of Circulations
   Rating
   Country Coverage
  India, Pakistan, Bangladesh     South Asia
   Cost
                      Black and White Color
  Full Page          
½ of Page          
¼ of Page          
   Language of Periodical
   Area of Coverage
   Name of Newspaper
   Do rates reflect 15% agency commission ?
       Yes No
   Write a brief comment about the
   station/program