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TO RESERVE ADVERTISING SPACE IN THE NEXT ISSUE OF FILMFAX MAGAZINE, PLEASE COMPLETE THIS FORM AND ENCLOSE IT WITH YOUR CHECK OR MONEY ORDER. PLEASE NOTE; PAYMENT IS NON- REFUNDABLE AND ADS MUST RUN CONSECUTIVELY.

PLEASE TYPE OR PRINT CLEARLY

NAME OF FIRM:________________________________________________________

NAME OF PERSON REPRESENTING FIRM:________________________________

STREET ADDRESS______________________________________________________

CITY___________________________________ STATE_________________ ZIP_____

PHONE # ( )_____________________________________

AD SPECIFICATIONS:

SIZE OF AD______________________ FREQUENCY OF INSERTION_________

ISSUE NUMBERS_____________________ COLOR_____________ B/W________

ARTWORK SPECIFICATIONS:

(CHECK ONE) FILM____ B/W CAMERA READY ART___ PMT or VELOX____

FORM OF PAYMENT:

CHECK FOR $_____________ MONEY ORDER FOR $______________

AUTHORIZED SIGNATURE_____________________________________

POSITION WITH COMPANY____________________________________

DATE______________________

MAIL TO: FILMFAX ADVERTISING P.O. BOX 1900 EVANSTON, IL 60204

If you require further information, Call MICHAEL STEIN at (847)866-7155