Docusign Envelope ID: 81E42FEF-3A47-44EE-81EB-3187A1F71ED0
Advertising Agreement Mailbox Publishings, Inc. 2081 SE Ocean Blvd. • Suite 4 • Stuart, FL 34996 Phone 772.334.2121 • Fax 772.334.2221
Fire Sign Pilates
04/17/26
Company Name _______________________________________________________ Date _____________________ Contact Name ________________________________________ Specific Business ___________________________ Address_________________________________________ City_________________ State _______ Zip __________ Phone __________________ Cell __________________ Email _________________________________________ Erin Hendrickson Pilates 959 SE Federal Hwy Stuart FL 34994 (315) 762-3915 firesignpilates@gmail.com
FIRST PAYMENT DUE WITH INSERTION AGREEMENT Please fill in the information below to authorize payment.
PAYABLE TO MY LIVING MEDIA
ACH – DIGITAL CHECK
973 SE Federal Highway
Sea Coast
Bank Name:_______________________________________________ Bank Address: ________________________________________________________
650.00
4157279797
067005158
Routing Number: ________________________________ Account Number: _____________________________ Amount: $________________________
❏ Check here to authorize automatic payments for each issue.
Authorized Signature:
________________________________________________
– CREDIT CARD –
3% CONVENIENCE FEE
Account Number:
_________________________________________________________ Exp Date: _______________ CVV Code:
__________
650.00
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*
Full Page
All Zones
1645 = 05/01/26
650.00
Full Page
All Zones
1647 = 05/29/26
650.00
Full Page
All Zones
1649 = 06/26/26
650.00
Full Page
All Zones
1651 = 07/24/26
650.00
Full Page
All Zones
1653 = 08/21/26
650.00
Full Page
All Zones
1655 = 09/18/25
650.00
Instructions:________________________________________________________________________________
Erin Hendrickson
Christopher Astoske
Print Name/Title Authorized Advertiser
Sales Representative
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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