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Advertising Request Form

Please fill out the following form to make a request for an advertisement:

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Organization Name: *

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Email Address: *

Street Address: *

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ZIP Code: *

Contact Phone: *
Format: XXX-XXX-XXXX

FAX:

Federal Tax Identification Number:

Has Gardners Candies contributed to your publication/event in the past?

Yes

If yes, describe when and how:

Describe the event or publication for which you are requesting the advertisement:

What is the audience and expected exposure (circulation) for this advertisement?

What is the size and cost of the advertisement that you are requesting?

What format (jpeg,pdf,etc) and color requirements do you need for the advertisement?

Additional Comments:

What is the deadline for the advertisement to be submitted?

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