Advertising Purchase Order

Advertising purchase order. Includes total purchase amount and terms of purchase.

Dated: Enter date of purchase order Purchase order number: Enter purchase order number

Advertising dates: Enter first date of advertising to Enter last date of advertising

TO: Enter name of provider of service

Attention: Enter name of provider's contact person

Enter provider's address

Enter city, state, zip code of purchaser

FROM: Enter name of purchaser

Contact person: Enter name of purchaser's contact person

Telephone number: Enter purchaser's contact phone number

Enter purchaser's address

Enter city, state, zip code of purchaser

TOTAL VALUE OF THIS PURCHASE ORDER: $ Enter total value of purchase order in numbers (Enter total value of purchase order in numbers dollars)

General conditions of purchase order:

Acceptance of this order must be by return of a signed copy of this form by an officer of Enter name of provider of service. Do not attach additional terms without prior telephone clearance from Enter purchaser's contact phone number. An affidavit of performance must be provided within thirty days of the conclusion of the last advertisement. Enter name of purchaser may request a weekly or monthly confirmation of proper performance. If advertising materials are to be prepared by Enter name of provider of service, the same must be provided for approval at least three working days prior to the deadline for first advertising to run. PARTIAL ACCEPTANCE IS NOT PERMITTED. If unable to provide all advertising specified, contact Enter purchaser's contact phone number immediately. Billings must reference the purchase order number and date. Periodic billing is permitted, not more frequenlty than every 30 days. Alterations or additions to this flight must be confirmed by an amended purchaser order. If advertising materials are provided by Enter name of purchaser, they must be returned unless otherwise noted after the last advertisement.

Terms: Enter terms

SEE ATTACHED SHEET FOR SPECIFICATIONS OF PURCHASE

____________________________________

Enter name of provider of service by an authorized officer

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