Misc Media Kit - Page 6

Annual Pictorial Roster Advertising CONTRACT Company Agency (if applicable) Contact(s) Mailing Address Billing Address (if different) Telephone Fax Email Address Website Signature Date Credit Card Visa Mastercard Discover American Express Return to: Card # Amanda Edmondson Dir. of Communications & Marketing Greater Louisville Medical Society 328 E. Main St. Louisville, KY 40202(502) 736.6330 Fax (502) 581-9022 amanda.edmondson@glms.org Expiration Name on Card Billing Address The above information is used to secure your ad placement. Your credit card will be charged if balance is not paid within 30 days following the billing date. Any unpaid balance after 30 days will be charged interest at the rate of 1½ % per month (18% per annum). You may charge by credit card if you prefer. Signature for contract confirmation Signature to charge credit card SIZE RATE Full Page $1075 Half Page $775 Quarter Page $550 Special Position $1875-5500 Tab Page Full $3150 Tab Page Half $1875 Continue with Same Ad New Ad Enclosed New Ad to Follow Estimated Delivery Date Circulation: 10,000