Date:

Salesperson Information:

Name:

Newspaper:

Address:

City:

Phone Number:

Lead Information:

Name of Account:

Advertising Contact Person for Account:

Address:

City:

Phone Number:

Agency for Account:

Contact Person at Agency:

Address:

City:

Zip Code:

Should sales contact be made with agency or account?
Agency
Account

Where do they advertise now?

Where else would they like to advertise?

Are they aware of NEPA's one-order, one-bill service?
Yes
No

Other Account Information:

I understand that if this account begins to advertise through the NEPA ad placement network within six months from today, I will receive $100 as a finder's fee and my newspaper company will receive $100.

Note: This offer is not available on accounts that have used the NEPA ad placement service in this calendar year or last calendar year.