| < Back to Co-op Info | Fields Co-op Advertising Request Form |
| Mail
To: 2240 Taylor Way Tacoma, WA 98421 (206) 627-4098 (800) 627-4098 Fax (206) 383-2181 |
Dealer: ________________________________________ Date: ______________ |
| Distributor Requesting Credit: |
______________________________________________ ______________________________________________ ______________________________________________ |
| Media: | Required Checklist: |
| Newspaper |
__ Full page Tear Sheet(s) __ Invoice |
| Catalog, Mailer, Circulars |
__ Complete Copy of Printed Material __ Proof of Cost for Printing & Distribution (Paid Invoices) __ Proof of Circulation |
|
Other (Prior Approval by Fields) Radio __ Television __ |
__ Paid Invoices and Evidence of Air Time |
|
Total Amount: ______________ 50%: ______________ |
|
|
For Fields Use Amount of Payment $: _____________________________ Approved By: ___________________________________ Date:__________________________________________ |
Please print and include this form with all calims.