New Client Entry Form

Your Name:

Your Email:

Client Name (please enter as appears on official documentation):

Direct/Agency Client:
DirectAgency
Agency Name (if required):

Type of Business (helps traffic separate orders/spots from similar advertisers):

Normal Billing Cycle:
BroadcastCalendar

Co-op:
NoYes

Address Line 1:

Address Line 2:

City:

State:

Zip:

Business Phone #:

E-mail Invoice (to billing contact):
Yes

*All new clients will be enrolled in e-mail invoicing (except agencies that use RadioInvoices.com services or clients that require cop-op invoices).

Billing Contact Name:

Billing Contact E-mail:

Billing Contact Phone #:

Additional Info/Notes
(which stations are you requesting this station for? also indicate if this is new business.):