Please fill out the information below.
(The RED Items
are required)
Contract #:
Advertiser:
Advertiser's
Representative:
Type of
Business:
Address:
City:
State:
Zip:
Phone:
Fax:
(
)-
(
)-
Ad
Size
Full Page
2/3 Page
1/2 Page
1/3 Page
1/4 Page
1/6 Page
1/12 Page
Description:
Vertical
Horizontal
Four Color
Black & White
Other
Terms
Date :
Starting with
issue
Ending with
issue
Special
Instructions*:
#
of Ad Insertions:
Cost
per Insertion:
Color
Charge:
Production
Charge(s):
Amount
in Trade:
Total
Contact:
$
*PayPal Payment
Please make payment by Check or wire
transfer or PayPal in the name of “Las
Vegas Hollywood” or in the name of our
“Official Agency Representative” after
this contract is signed and approved
by both Parties.
I hereby warrant that I have read the
Contract
Terms & Conditions
as spelled out and that I have full
power and authority to sign for the
above named firm.
Advertiser's
Representative Name:
Title:
Date:
Email:
Las Vegas-Hollywood
Rep:
Date:
Las Vegas-Hollywood
Magazine
Attn: Advertising Dept.
P.O. Box 15187
Las Vegas, NV 89114
2007 Las Vegas Hollywood Magazine. All Rights Reserved