Docusign Envelope ID: 3069EE18-88CE-8A63-82E7-B3FD0755F97C
Advertising Agreement Mailbox Publishings, Inc. 2081 SE Ocean Blvd. • Suite 4 • Stuart, FL 34996 Phone 772.334.2121 • Fax 772.334.2221
644 - Cohen’s Optical PGB Rita - Full page $947
Cohen’s Optical Botique
4/21/26
Company Name _______________________________________________________ Date _____________________ Contact Name ________________________________________ Specific Business ___________________________ Address_________________________________________ City_________________ State _______ Zip __________ Phone __________________ Cell __________________ Email _________________________________________ Mdimarco@cohensfashionoptical.com Store# 561-839-7500 NY 11530 516-662-2015 100 Quentin Roosevelt (Alton Store #338) Mary DiMarco Garden City Optical
FIRST PAYMENT DUE WITH INSERTION AGREEMENT Please fill in the information below to authorize payment.
PAYABLE TO MY LIVING MEDIA
ACH – DIGITAL CHECK
Bank Name:_______________________________________________ Bank Address: ________________________________________________________
Routing Number: ________________________________ Account Number: _____________________________ Amount: $________________________
❏ Check here to authorize automatic payments for each issue.
Authorized Signature:
________________________________________________
– CREDIT CARD –
3% CONVENIENCE FEE
Grand Opening! From New York to Florida, Cohen’s brings generations of trusted Eye Care to you! • State-of-the-Art Eye Exams • Designer Frames & Sunglasses • All Brands of Contact Lenses • We Accept Most Insurance Plans Where Luxury meets Personalized Service
Account Number:
_________________________________________________________ Exp Date: _______________ CVV Code:
__________
Authorized Signature:
_____________________________________________________________________ Amount: $______________
❏ I hereby authorize automatic payments for each issue
Billing Zip Code: _____________________________
ADVERTISING PROGRAM
Vol. #
In Home
Size
Zone (s) / Section (s)
Investment*
957.00
D I N
644 - 04/29/26
Full Page
645 - 05/13/26
957.00
D I N
Full Page Full Page
PROGRESSIVE EYEGLASSES FRAME + MULTI-FOCAL LENSES ** $ 299 $ 350 SAVE UP TO ACUVUE CONTACT LENSES ^^
50
D I N
957.00
% OFF
957.00
D I N
Full Page
957.00
D I N
Full Page
D I N
957.00
Full Page
DESIGNER FRAMES WITH LENS PURCHASE *
D I N
957.00
Full Page
D I N
957.00
Full Page
FREE BLUE-LIGHT LENS FILTER FOR KIDS
957.00
D I N
Full Page
957.00
D I N
Full Page
957.00
D I N
Full Page
957.00
D I N
Full Page
WITH EYEGLASS PURCHASE ^
957.00
D I N
Full Page
& More
Instructions:________________________________________________________________________________ Front Covers TBD to add on for additional $300 each
Visit Us & Book Your Eye Exam Today! Alton Town Center, Suite 110 • Palm Beach Gardens 561.652.6596
Mary DiMarco
Rita Kapper
Print Name/Title Authorized Advertiser
Sales Representative
GF
*Valid with lens purchase. Certain designers excluded. **Select frame with select clear plastic progressive lenses +/-4sph., 2cyl. up to 3.00add. ^Valid with lens and frame purchase. ^^Reward amount dependent on ACUVUE ® product and quantity purchased and if you are a new wearer. Must get an eye exam and purchase the product. Original receipt required. For Reward Terms and Conditions, visit https://rewards.promo.acuvue.com/#/rewardsTerms . For Important Safety Information, visit https://www.acuvue.com/en-us/important-safety-information/. Offers not valid with any other offers, discounts or insurance plans. See store for details. Offers end 6/30/26.
Authorized Signature of Advertiser
Sales Manager
The undersigned states that he/she is authorized by the above business to sign this Agreement and agrees to be personally liable, jointly, and severally, under this contract regardless of wether or not he/she has any ownership interest in above business; and agrees to abide by all terms of this contract. This agreement is not in effect until accepted and approved by Mailbox Publishing management.
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