Advertising Agreement To get started fill out the form below and a staff member will be in touch. Please enable JavaScript in your browser to complete this form.Name of Business: *Contact: *Contact Title:Address: *Address Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeBusiness Phone: *Cell Phone:Fax:Email: *EmailConfirm EmailBusiness Website:Best method of contact: *EmailMobile LandlineWould you like to receive: *Electronic invoices via emailPaper via U.S. MailOr both?Advertisement TypesWebsite / Mobile App Advertisements3x1 Tile Advertisement - $ 225.003x3 Box Advertisement - $ 325.008x1 Banner Advertisement - $ 425.00*Billed monthly. Broadcast Commercial Advertisements15-second Commercial - $ 225.0030-second Commercial - $ 325.0060-second Commercial - $ 425.00*Billed monthly. Brand SponsorshipBrand Sponsorship - $ 175.00*Packages start at $175 per-month and range based on desired services.Production ServicesWeb Advertisement Production - $ 25.00Video Advertisement Production - $ 150.00Client Submitted Advertisement - $ 0.00*Advertisements must be submitted in a MP4 or JPEG format 24-hours prior to publication. Web advertisement production services start at $20 per hour. Video advertisement production services are $100 per session, with additional work billed at $20 per hour.Payment Information*Please complete all fields. This authorization will remain in effect until cancelled by the client.Payment Information, Card Type: MasterCardVISADiscover AMEXOther Cardholder Name (as shown on card)Card Number: (e.g. 4012-8888-8888-1881)Expiration Date (mm/yy): Card Verification Code (CVC): Cardholder ZIP Code (from credit card billing address): Total$ 0.00Advertiser Name *FirstLastI agree to the terms & conditionsThe client will be billed each month until we are directed to stop the campaign. Check or electronic payment should be made to “WNY Media Company.” First payment due upon receipt, following payments due NET 30. Termination of this agreement will not eliminate outstanding balances. This agreement shall be legally binding upon the parties’ signatures. Submit