This document is an advertising insertion order form for a publication. It requests information from advertisers such as company details, ad specifications, payment options, and a signature authorizing the placement and cost of ads for issues of the publication throughout the year. The form provides advertising rates and guidelines and is to be returned with payment or credit card information to reserve ad space in upcoming issues of the builder magazine.

1. builder®
Advertising Information
ADVERTISER: CONTACT/AGENCY:
ADDRESS:
CITY: STATE: ZIP CODE:
PHONE: FAX:
EMAIL: WEBSITE:
ADVERTISER CATEGORY:
SIZE/ORIENTATION/COLOR OPTION:
FREQUENCY: RATE:
PICK UP ARTWORK FROM: NEW MATERIAL TO ARRIVE BY:
AUTHORIZED SIGNATURE:
DATE:
Place in Issue
January/February March/April May/June
July/August September/October November/December
Payment
PAYMENT OPTIONS (CHECK ONE):
CHECK ENCLOSED BILL ME
BILL MY: VISA MASTERCARD AMERICAN EXPRESS
CREDIT CARD #:
EXPIRATION DATE: SECURITY CODE:
NAME ON CARD:
SIGNATURE:
TOTAL DUE:
Return this completed form to Peter Embrey at pembrey@artba.org.
For more information, contact ARTBA’s Peter Embrey at 202.289.4434 or pembrey@artba.org.
ADVERTISING INSERTION ORDER FORM