11/17


NATURAL AWAKENINGS TWIN CITIES Twin Cities Publishers


adagreement


Complete this form and send to: Email: Publisher@NAtwincities.com Fax: 763-210-6862


Check One: q 1-5 Months q 6-11 Months q 12 Months q Other


1st mo/yr


PRICE WORKSHEET Display Ad


Display Ad Size .............. . . . . . . List Rate / Month ............. . . . . . .$ (Other)..................... . . . . . . DISPLAY AD TOTAL ......... . . . . . . $


Directory Listings Economy, Basic or Premium? . . . . . . . . . Natural Directory List Rate . . . . . . . . . . .$ (Other)..................... . . . . . . NATURAL DIRECTORY TOTAL. . . . . . . $


EXTRAS AND DESIGN FEES Extras


......


DESIGN FEES .............. . . . . . . $ 1st MONTH TOTAL ........ $


Regular MONTHLY FEE ... . $ (This fee will be different from the 1st month total only if you are charged a design fee the first month)


January 2018 Annual Directory Display Ad Size ............. . . . . . . Display Ad Cost.............. . . . . . .$ 1st Listing .................. . . . . . .$ $99 until 9/30/17 $125 after 10/1/17 2nd Listing ($50) . . . . . . . . . . . . . . . . . . .$ 3rd Listing ($25) ............. . . . . . . Total Directory TOTAL


/ Last mo/yr /


Business: Address: City:


Phone:


Email: Website:


PAYMENT INFORMATION Card Type:  VISA  MasterCard  American Express  PayPal  Check


 Itex


Name on Card: Account No: Expiration:


Billing Address for Card:


Address: City:


State:


Candi Broeffle: Candi@NAtwincities.com Jody Janati: Jody@NAtwincities.com Phone: 763-270-8604 | Fax: 763-210-6862 NAtwincities.com


CONTACT INFORMATION Name:


Date:


State: Fax:


Zip:


Security Code:  Same as Above Zip:


BILLING: Automatic credit card charging occurs between the 10th and 12th of the month prior to publication (unless agreed otherwise). We chose not to send monthly bills. Charge confirmation will appear on your credit card statement.


LATE PAYMENTS: Any past due payments due to Natural Awakenings may be charged to the credit card on file.


BILLING INSTRUCTIONS


I authorize Natural Awakenings Twin Cities to bill the card listed below for fees and terms on this contract: X


AUTHORIZED SIGNATURE


I certifiy that I am an authorized representative of the company shown, I agree to the terms and conditions specified on this contract, and I understand the cancellation penalties and payment policies


NOTES & SPECIAL INSTRUCTIONS:


$


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