This document is an advertising information and insertion order form for a transportation organization. It requests contact information for the advertiser and agency. It lists online advertising options on various sections of the organization's website and their newsletter. It provides fields to select payment options, credit card information, total due, and contact for any questions. The advertiser would complete and return this form to reserve ad space.

1. Advertising Information
ADVERTISER: CONTACT/AGENCY:
ADDRESS:
CITY: STATE: ZIP CODE:
PHONE: FAX:
EMAIL: WEBSITE:
APPROVAL SIGNATURE:
Online Advertising Options
Section of ARTBA Website: ARTBA Store Home Page Advocacy Section Main Page
Economics & Research Main Page Safety Section Main Page
Digital ARTBA Washington Newsline
Month(s) to appear on website (please circle): Jan. Feb. Mar. April May June
July Aug. Sept. Oct. Nov. Dec.
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.
1219 28th
Street N.W.
Washington, DC 20007
T: 202.289.4434 F: 202.289.4435
www.artba.org
WEBSITE ADVERTISING INSERTION ORDER FORM