Pre-Approval Form

Submit this electronic form with proposed advertising/promotional materials for pre-approval. (Required fields in bold.) This form will be returned to you and must accompany your co-op claim submission. You will receive a response in 3-5 business days.

One  
Customer Number:
Company Name:
Customer Name:
Address:
City:
State/Province:
ZIP/Postal Code:
Country:
Phone:
Fax:
E-mail:
Key Contact Person:
Key Contact E-mail:
Date:
Two  
Program Description:
Three  
Purpose of Advertisement
and/or Promotion:
Four  
Target Audience:
Five  

Target Media:
(Please check the appropriate
box or detail under “Other”)











Six  
Estimated Cost:
Seven  
Promotional Period:
  Provide start and end dates of promotion.
Eight  
Documentation: Attach proposed layout or script. (PDF, JPG or Word documents)


This form will be returned to you and must accompany your claim submission.