Advertising Promotional Tie-In Coordination Form

Please complete the following form in as much detail as possible to avail of our Advertising Promotional Tie-In Services.

Your Name:	Jonathan Wilkins
Company Name:
Description of the product/service to be promoted:
Promotion details:
Target demographic:

Please ensure that all entered information is accurate and valid. Incomplete forms or forms providing false information will not be considered.

Prepared by:
Date:

Note: Submitting this form does not guarantee acceptance of your proposed promotional tie-in.

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