Docusign Envelope ID: 1EA77A01-BC51-8130-808A-0D2E47E3C1DD
Advertising Agreement Mailbox Publishings, Inc. 2081 SE Ocean Blvd. • Suite 4 • Stuart, FL 34996 Phone 772.334.2121 • Fax 772.334.2221
Level 5
5/14/26
Company Name _______________________________________________________ Date _____________________ Contact Name ________________________________________ Specific Business ___________________________ Address_________________________________________ City_________________ State _______ Zip __________ Phone __________________ Cell __________________ Email _________________________________________ Daniel Gonzales Painting 16737 Mellen Lane Jupiter FL 33478 561-768-6487 Sololevel5@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
03-31
8959
379256033143026
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*
I I I I I I I I I I I I I
646-6/3/26 647-6/17/26 648-7/1/26 649-7/15/26 650-7/29/26 651-8/12/26 652-8/26/26 653-9/9/26 654-9/23/26 655-10/7/26 656-10/21/26 657-11/4/26 658-11/18/26
1/4V 1/4V 1/4V 1/4V 1/4V 1/4V 1/4V 1/4V 1/4V 1/4V 1/4V 1/4V 1/4V
99.00 99.00 99.00 99.00 99.00 99.00 99.00 99.00 99.00 99.00 99.00 99.00 99.00
Instructions:________________________________________________________________________________
Print Name/Title Authorized Advertiser Daniel Gonzales
Sales Representative Rita Kapper GF
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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