Insertion Order Form
Advertising Type
*
Please Select
Retail
Classified
Silver Wings
Advertiser
*
Agency/Account Number
Date Ticket Created
 /
Month
 /
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Salesperson
*
Please Select
Amber Dumas $130
Beth Proffitt #140
Luther Shields #110
Mary Jane Runnels #100
Melissa Johnson #60
House #30
AD Number
Run Dates
*
Pick Up
Yes
No
Pick Up Date
AD Caption
*
Billing Instructions• Section/Position
Columns
Please Select
0
1
2
3
4
5
6
Inches
Please Select
0
1
.25
.5
.75
1
1.25
1.5
1.75
2
2.25
2.5
2.75
3
3.25
3.5
3.75
4
4.25
4.5
4.75
5
5.25
5.5
5.75
6
6.25
6.5
6.75
7
7.25
7.5
7.75
8
8.25
8.5
8.75
9
9.25
9.5
9.75
10
10.25
10.5
10.75
11
11.25
11.5
11.75
12
12.25
12.5
12.75
13
13.25
13.5
13.75
14
14.5
14.75
15
15.25
15.75
16
16.25
16.5
16.75
17
17.25
17.5
17.75
18
18.25
18.5
18.75
19
19.25
19.5
19.75
20
20.25
20.5
20.75
21
21.25
21.5
Rate
Please Select
Contract Rate
Open Rate $13.80
Classified Rate $10.35
Birthday/Memorial $11.80
Employment $13.80
Legal Display $10.35
Civic Rate $11.80
Total Ad Inches
Contract Rate
o 1/2 Price
Special Rate Charge
Color
*
Please Select
Color
Black & White
Both as Available
Color Charge
Please Select
COMP
$35 - 15.75" & Below
$65 - 31.5" & Below
$125 - 105" & Below
$200 - !29" & Below
Total Price Per AD
Proof To
Customer's e-mail address or proof to AD REP
Design Instructions
Submit
Should be Empty: