Premium Media - Managed Placement and/or Service Subscription Agreement Addendum


Proposal Date:
*Please note, this addendum will expire at Midnight EST on the seventh (7) calendar day from the date listed above if not signed before.

Your Account Representative:

The below details confirm the managed order for for execution between and  pursuant to the following quantities, rates, networks, locations, and terms:

Placement or Program Notes

Placement Details

Location(s)

Day Part(s)

Flighting

Targeting

Agreed upon CPM, CPC, CPP or other rate(s)

Notes

Service Requirement

Deliverable(s)

Rate(s)

Other Notes

Subscriber acknowledges ACH payment details and authorization for debit in the total amount above must be granted in order to avoid a 20% processing fee.  Subscriber ACH details are as follows:

Bank Account Type 
 

Bank Account Number 
 

Bank Account Routing Number 
 

Bank Account Holder Name 
 

 

Thank you for the opportunity to earn your business!

Leave this empty:

Five Tier, Inc. https://www.fivetier.com
Signature Certificate
Document name: Premium Media - Managed Placement and/or Service Subscription Agreement Addendum
Unique Document ID: 355e276bd40c651baea0094856b611381f97c7a3
Timestamp Audit
September 28, 2017 5:02 pm ESTPremium Media - Managed Placement and/or Service Subscription Agreement Addendum Uploaded by Frank O'Brien O'Brien - frank.obrien@fivetier.com IP 104.162.193.170