Advertising Submission Form - Mothers of Supertwins

MOST
(Mothers of Supertwins)
P.O. Box 306 * East Islip, New York11730 * (631)859-1110 * www.MOSTonline.org
Advertising Submission Form
General Information
Company
Address
City State Zip Code
Contact
Email
Phone
Your advertisement will be directed
primarily at (check all that apply):
Expectant parents of multiples
Parents of multiples
Health care professionals
Other
In which MOST media do you wish to
place your advertisement
(check all that apply):
Fax/Mobile
Product or
Service
SUPERTWINS Magazine Ads
SUPERTWINS
MOST Website
MOST e-News
Ad Exchange
Advertisement
frequency:
Single insertion Annual insertion (4 times a year) Polybagged Mailling
Advertisement edition(s)
(check all that apply):
Spring Year
Summer Year
Fall Year
Winter Year
Inside front
2/3 horizontal
1/6 double horizontal
Advertisement size(s)
(check all that apply):
Inside back cover
Back cover
1/2 horizontal
1/3 horizontal
1/2 vertical
1/3 vertical
Full Page
1/6 horizontal
1/6 vertical
MOST Website Ads
Advertisement
length:
3 months
6 months
12 months
24 months
Ad Start Date:
Advertisement size (please describe):
Website
Pages:
Home Page Store Page Multiples in the News PreemieCare
Other ((please list):

MOST
(Mothers of Supertwins)
P.O. Box 306 * East Islip, New York11730 * (631)859-1110 * www.MOSTonline.org
MOST e-News Newsletter
January
Year
May
Year
September
Year
Which e-News
Edition (check all
that apply):
February
March
Year
Year
June
July
Year
Year
October
November
Year
Year
April
Year
August
Year
December
Year
MOST Parenting Booklets
Level of Sponsorship
Level A Level B Level C Level D
Name of Booklet
Advertising Exchange
Please describe
conditions:
SUPERTWINS Ads
Website Ads
Total Costs
Payment Information
Enter total cost for each media, setup fee, and
total contract. Rates available in MOST Media Kit.
Booklet Ads
Setup Fee
Terms of Agreement
1. Payment is due 30 days from the
initiation of contract. All checks
payable in US funds. Late fees may by
applied to outstanding accounts.
e-News Ads
Card #:
Grand Total
Full payment enclosed Invoice required Purchase order #:
Visa MasterCard American Express
Name &
address on
credit card:
Expiration Date
2. Cancellations must be sent in
writing prior to ad deadline.
Advertisers will be billed for stop
payment or collection costs.
3. Accounts outstanding after 45
days forfeit all discounts and
advertising is suspended after 2
publications without payment
( website 60 days from start date)
until payment is received.
4. Advertiser must pay contracted
costs if ad materials fail to arrive
before deadline.
Signature:
Print name:
Date:
If you have questions, call
(631) 859-1110
Once form is complete, please print, sign, date and return to:
MOST: PO Box 306; East Islip, NY 11730-0306 or fax (631) 859-3580