Circulation Sheet for Elliot Institute ‘s Hope and Healing

Insertion Order for Hope and Healing


Dear Advertising Editor:

To ensure correct placement of Hope and Healing in your newspaper, please fill out the following information and return this sheet to the organization listed below.

Name of School:________________________________________________________

Name of Newspaper:____________________________________________________

Contact Name:_____________________________ Phone: _____________________

Fax:________________________ Email: ___________________________

Date inserts will be placed in your newspaper: ________________________________

Deadline date for inserts to be delivered: ____________________________________

Circulation for your newspaper: ___________________________

Insertion Cost Per Thousand: ____________________________

Total Cost: __________________________________

Mailing Address: _______________________________________


Shipping Address: ____________________________________

(for delivery of inserts) ____________________________________

Shipping Instructions:

Do you have a loading dock, so that the inserts can be delivered on a pallet? YES NO (If not delivered on pallet, will be delivered in boxes.)

Should the inserts be delivered UNFOLDED (11.375″ x 13.5″) or FOLDED (Folded in half 11.375″ x 6.75″) (circle one) UNFOLDED FOLDED

Before signing, please verify that the above information is complete and accurate.

Signature of Approval __________________________________________________________

Please mail or fax this sheet to:

(Person or organization arranging for the insert should place their name and address and phone number in the place noted above and forward a signed copy of the order to:

Elliot Institute PO Box 7348 Springfield, IL 62791-7348 Phone: 217-525-8202


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