Insertion Agreement - Inserts & DAL Mailbox Publishings, Inc. 2081 SE Ocean Blvd. • Suite 4 • Stuart, FL 34996 Phone 772.334.2121 • Fax 772.334.2221
Coastal Illumination
4/28/26
Company Name _______________________________________________________ Date _____________________ Contact Name ________________________________________ Specific Business ___________________________ Address_________________________________________ City_________________ State _______ Zip __________ Phone __________________ Cell __________________ Email _________________________________________ Diane Castro Outdoor Lighting 6032 Sunberry Circle Boynton Beach FL 33437 561-586-2538 coastaliluminagtion@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
OnFile
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
Account Number:
_________________________________________________________ Exp Date: _______________ CVV Code:
__________
Authorized Signature:
_____________________________________________________________________ Amount: $______________
❏ I hereby authorize automatic payments for each issue
Billing Zip Code: _____________________________
INSERT/DAL - ADVERTISING PROGRAM
Vol. #
In Home
Product
Zone/Zip
Quantity
Investment*
645-5/20/26 645-5/20/26 645-5/20/26 646-6/3/26 646-6/3/26 646-6/3/26 646-6/3/26 646-6/3/26 646-6/3/26
8.5 x 11 Insert - 2 Sides 8.5 x 11 Insert - 2 Sides 8.5 x 11 Insert - 2 Sides 8.5 x 11 Insert - 2 Sides 8.5 x 11 Insert - 2 Sides 8.5 x 11 Insert - 2 Sides 8.5 x 11 Insert - 2 Sides 8.5 x 11 Insert - 2 Sides 8.5 x 11 Insert - 2 Sides
662.76 290.76 143.40 252.60 252.72 497.28 60.36 182.52 262.56
EFull Zone
5,523 2,423 1,195 2,105 2,106 4,144 503 1,521 2,186
I533410 I733408
D133458 D133477 D333469 D433477 D533469 D633458
❏ Print & Deliver ❏ Single Print Run Instructions:________________________________________________________________________________ ❏ Print Only ❏ Pre-Printed SeePage2
Diane Castro
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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