WJAY RADIO Sales Order Form

WJAY RADIO Sales Order Form

SALES ORDER E-FORM
CLIENT INFORMATION

Please complete this section of the order form.
TODAY'S DATE:*

MonthDayYear
Date
CLIENT NAME/BUSINESS NAME:*
BILL TO/ATTENTION:*

First NameLast Name
BILLING ADDRESS:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
PHONE NUMBER:*
Please enter a valid phone number.
PHONE TYPE:*

BusinessCellHome
EMAIL:*
example@example.com
ALTERNATE PHONE NUMBER:
Please enter a valid phone number.
ALTERNATE PHONE TYPE:

BusinessCellHome
AIRTIME FOR:*
UPLOAD AUDIO IN MP3 FORMAT (IF APPLICABLE):

Issues uploading the audio file? Email it to wjay.mp3@gmail.com.
Cancelof
UPLOAD DOCUMENTS (IF APPLICABLE):

Issues uploading a document? Email it to wjay.info@gmail.com.
Cancelof
DESIRED START DATE: *

MonthDayYear
Date
DESIRED END DATE:

MonthDayYear
Date
SPECIAL INSTRUCTIONS: (Include day/time requests for content to air on WJAY. If none specified or if request is unavailable, content will air at best day/time available as determined by station.)
PROMO CODE:
TERMS

This contract is subject to all Federal, State and Municipal laws and regulations now in force or which may be enacted in the future. ELPISynergy Enterprises, Inc and WJAY 98.3 FM & 1280 AM production staff are not responsible for the validity or accuracy of ad or broadcast content submitted by the client(s). In return for said service, the Advertiser agrees that payments are to be made as follows:
Are you the client?*

YesNo
PAYMENT METHOD:*

Debit/CreditCashCheckMoney OrderOther
PAYMENT AMOUNT ($):*
Enter total amount due here (ie. $75.00). If unsure, please contact WJAY RADIO (843) 561-3021 or wjay.info@gmail.com for rates and prices. Payment is required for orders to be processed.
PAYMENT FREQUENCY:*

One time paymentMonthly recurring payment
I, the Client, agree to the WJAY RADIO Terms.*

Yes, I agree.
CLIENT SIGNATURE:*

Clear
**OFFICIAL USE ONLY ** WJAY RADIO STAFF**

This section is to be completed by WJAY RADIO Staff ONLY.
AIRTIME TYPE: (Check all that apply.)

CommercialBroadcastLive ReadRecurringPoliticalLive RemotePSA
COMMERCIAL LENGTH:
COMMERCIAL AD CAMPAIGN:
BROADCAST LENGTH:
BROADCAST NAME:
START DATE:

MonthDayYear
Date
TFN:

YesNo
END DATE:

MonthDayYear
Date
CANCEL DATE:

MonthDayYear
Date
SPECIAL INSTRUCTIONS: (Include special airing requests or notes for airtime. If none specified, content will air at best time available.)
PAYMENT RECEIVED:

Debit/CreditCashCheckMoney OrderOther
CHECK/MONEY ORDER NUMBER:
COST:

* Ad/Broadcast Rate $Rate X Number of spots # of spots
(Broadcast rate is per broadcast aired. Total below is the monthly cost to air broadcast. Depending on the calendar, a weekly broadcast may air 5x per month instead of 4x. This change will increase your bill for that month.)
* Other Product
* TOTAL $Total
SOLD BY:
WJAY RADIO REPRESENTATIVE/STAFF OR HOUSE
SUBMITTED BY:
WJAY RADIO REPRESENTATIVE/STAFF

ORDER PROCESSING:

	B	PA	I	S	P	F
INTERNAL USE ONLY

INVOICE/RECEIPT:
Should be Empty:

WJAY RADIO Sales Order Form

CLIENT INFORMATION

TERMS

**OFFICIAL USE ONLY ** WJAY RADIO STAFF**

COST:

OFFICIAL USE ONLY WJAY RADIO STAFF**