Union Reporters Monthly

FULL NAME

First Name Last Name

BILLING ADDRESS

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

YOUR EMAIL ADDRESS

BUSINESS PHONE:

OTHER CONTACT NUMBER

SPECIAL BILLING INSTRUCTIONS (i.e. Split payments, etc)

When Paying By Business Or Personal Check Please Include The Following Information:

FULL NAME (As it appears on the check)

BANK NAME

BANK ACCOUNT TYPE

ACCOUNT NUMBER

ROUTING NUMBER

YOUR WEBSITE ADDRESS so we can link your listing to your website)

PLEASE READ THE LOA BELOW

BY ENTERING MY NAME IN THE BOX TO THE RIGHT, I AUTHORIZE PLANNMEDIA TO CHARGE MY CREDIT CARD/BUSINESS ACCOUNT MONTHLY THE AMOUNT OF $29.95 MY. I UNDERSTAND I HAVE 72 HOURS TO CANCEL MY PURCHASE WITH PLANNMEDIA BY EMAILING MY REQUEST TO support@plannmedia.com I HAVE READ AND AGREE TO THE TERMS AND CONDITIONS OF PLANNMEDIA CANCELLATION POLICY.

YOUR REPRESENTATIVES NAME

NOTE: THE PROCESS FOR POSTING ALL LISTINGS IS UP TO 30 DAYS. PLEASE ALLOW THIS TIME FOR US TO BUILD AND POST YOUR LISTING/LISTINGS TO OUR WEBSITE.

WE ASK THAT IF YOU HAVE ANY PICTURES, LOGOS, SPECIAL VERBIAGE (etc.) THAT YOU WOULD LIKE US TO USE, SUBMIT THOSE TO support@plannmedia.com AS SOON AS POSSIBLE.

Full Name

First Name Last Name

COMPLETE COMPANY NAME

COMPANY PHONE NUMBER

BUSINESS ADDRESS

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Add your URL (if you have your own website, we can link it to your listing)

E-mail

Special Instructions (include State, Counties, Categories, Listings, Key Words. Purchased

Description of Products and Services(Tell us what you do)

Description of Discount to Appear on Ad (not required)

My Products

Monthly Sponsorship ( $ 29.95 for each month.)

Email

Credit Card Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

Credit Card Details
First Name	Last Name
Credit Card Number	Security Code
Expiration Month	Expiration Year

Do you have any of the following social media? We can add them to your listing(s):
FACEBOOK GOOGLE+ TWITTER
FOUR SQUARE LINKEDIN INSTAGRAM

Paste Facebook URL

Paste Google+ URL

Paste Twitter URL

Paste Four Square URL

Paste Linkedin URL

Paste Instagram URL