Advertising Agreement Mailbox Publishings, Inc. 2081 SE Ocean Blvd. • Suite 4 • Stuart, FL 34996 Phone 772.334.2121 • Fax 772.334.2221
645 - Coastal Consignment Gina - 1/4 page $99
Company Name _______________________________________________________ Date _____________________ Contact Name ________________________________________ Specific Business ___________________________ Address_________________________________________ City_________________ State _______ Zip __________ Phone __________________ Cell __________________ Email _________________________________________ COASTAL CONSIGNMENT BOUTIQUE, THE 05/06/2026 Harold, (Hal) Wagner Consignment/Thrift 5716 South Dixie Highway West Palm Beach FL 33405 561-888-3838 561-905-0055 thecoastalconsignmentboutique@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
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
4427 3225 5011 3273
05/31
255
Account Number:
_________________________________________________________ Exp Date: _______________ CVV Code: __________
Authorized Signature:
_____________________________________________________________________ Amount: $______________
33405
❏ I hereby authorize automatic payments for each issue
Billing Zip Code: _____________________________
ADVERTISING PROGRAM
VOL. #
SIZE
VOL. #
SIZE
Investment* Zone (s) / Section (s
Investment* Zone (s) / Section (s
$99.00 $99.00 $99.00 $99.00 $99.00 $99.00 $99.00 $99.00 $199.00 $199.00 $199.00 $199.00 $199.00
$199.00 $199.00 $199.00
1/2H 1/2H 1/2H
1/4V 1/4V 1/4V 1/4V 1/4V 1/4V 1/4V 1/4V 1/2H 1/2H 1/2H 1/2H 1/2H
Y - Main - (incl Article) Y - Main - (incl Article) Y - Main - (incl Article) Y - Main - (incl Article) Y - Main - (incl Article) Y - Main - (incl Article) Y - Main - (incl Article) Y - Main - (incl Article)
Y - Main Y - Main Y - Main
658 659 660
645 646 647 648 649 650 651 652 653 654 655 656 657
Y - Main Y - Main Y - Main Y - Main Y - Main
** See Attached Signed Orignal Agreement Gina Miscavage
Instructions:________________________________________________________________________________
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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