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Ad/Material Request Form

This form should only be used to request ads and/or materials from existing advertisers in existing publications. If you are interested in advertising please use ourĀ advertiser request form.

Fill Out The Form Below & Click Submit

Please Be Advised:

  • Items in bold are required
  • Due to certain licensing agreements and regulations not all requests can be granted
  • Requests are processed Monday-Friday, 8am-5pm EST
  • Please allow 1 to 3 business days for the initial response to your request.
  • Ads will not be released until the first in-home date of the associated print publication.

Media Requested By:

Your Name (First & Last)

Company Name



Company Address

City (required)

State (required)

Zip/Postal Code

Media Type:

Request Comments:
(Please include a brief description of what you are requesting and/or any pertinent information that may help us get you the exact media that you are requesting.)

Media Requested On Behalf Of:

Advertiser/Client Name:

Advertiser Account #:

Advertiser Phone:

Contact Name:

Contact Phone:

Deliver Media To:

Recipient Name:

Recipient Phone:

Media To Be Received Via:
EmailFedEx (Data CD)

Recipient Email:

Recipient Address

City (required)

State (required)

Zip/Postal Code

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