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Advertising Request Form

Please complete this form as fully as possible so we can start your job quickly.

Date:
Contact name:
Email address:
Phone number:
Department Account Number:		for billing purposes
What you want to promote:
Date(s) to run advertising:
Amount to spend:
Print:
Radio:
Television:
Print Choices:		Farmington Daily Times Durango Herald Gallup Independent Navajo Times Aztec Local News Four Corners Business Journal
Radio Choices:		Adult Contemporary Classic Rock Country Christian Navajo Speaking Spanish Speaking Oldies
Television Choices:		KOBF - NBC Affiliate KOAT - ABC Affiliate KREZ - CBS Affiliate Cable
Comments: