Sales Form

Today's Date *

For Station *

JAX

BWK

Both

Client Status *

New

Returning

Updating Information Only

If Remote, DJ to pay

Business Information

Business Name *

Business Phone *

Website/URL

Contact Name *

Cell Phone *

Email Address *

Business Address

Business Address Line 1 *

Business Address Line 2 (optional)

City *

ST *

Zip Code *

Billing Address

Billing Address Line 1 *

Billing Address Line 2 (optional)

City *

ST *

Zip Code *

Notes or Instructions (if none, say "N/A") *

Financial Information

Run Dates (Example 4-1-18 thru 4-30-18) *

Agreed Upon Amount *

Payment Frequency *

Total 1 time

Monthly

If monthly, how many times?

Start Date *

If other, explain...

*If credit card, for safety/privacy, please have client enter card info via wayradio.org/donate or you enter it then dispose of number. Otherwise, please call Susanna with card info then dispose of number. Thanks!

Financial Notes/Instructions

Production

Produced by *

Copy *

Production Notes/Instructions (if none, state N/A) *

Promotion

Promote Via *

Business support page

Web calendar

Concerts/events page

Web/app banner

E-blast? *

Yes

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