Political Ad Disclosure Advertising Form

Complete all sections of the form accurately and truthfully. Ensure compliance with all applicable federal, state, and local laws regarding political advertising.

Advertiser Information:

Advertiser Name:	[Advertiser Name]
Contact Person:
Address:
Phone Number:
Email Address:

Political Advertisement Details:

Ad Title:	[A Brighter Future]
Campaign:
Date of First Air:
Ad Duration:
Media Types:

Financial Information:

Total Budget:	[$250,000]
Source of Funds:
Date of First Air:
Payment Terms:
Media Types:

Compliance and Certification:

I hereby acknowledge that the advertisement fully complies with all applicable federal, state, and local laws and regulations pertaining to political advertising.

Content Verification:

I confirm that the content of the advertisement is accurate, contains no prohibited material, and adheres to ethical advertising standards as set forth by regulatory authorities.

Disclosure of Affiliation:

This advertisement is not directly or indirectly affiliated with any political parties, candidates, or political action committees (PACs), other than those explicitly mentioned in the ad content.

Signature of Authorized Representative:

[Your Name]

[Job Title]

[Date]

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