Advertisement Placement Request Form

1) Save this Form onto your computer - Click Edit/Select All/Copy into NotePad.
2) Type Information into this Form & Save on your computer - File/Save As, name it AdForm.txt.
3) Email this form and your ad image, as attachments, to admin@TheMathWebSite.com . 

Client/Company Name :
Address :
City : 
State/Province :
Zip/Area Code : 
Telephone :  
E-mail :  
Authorized By : 

Ad is to be placed on Webpage (give URL) : 
Ad is to be linked to Webpage (give URL) : 
Ad dimensions :  Width (pixels) :             Height (px) :          Size (KB) :  
Ad location on the above Webpage : 
..... In top middle section below Logo (replacing Google Banner)
..... In middle left section over the Navigation Column 
..... In middle left section below the Navigation Column 
..... In middle right section at top (above Google Skyscaper)
..... In middle right section (replacing Google Skyscaper)
..... At the bottom left tile ad position
..... At the bottom middle banner ad position
..... At the bottom right tile ad position
..... Special Location : bottom of main middle middle section
..... Other - Specify ad size & alternate location 

Total Cost in U.S.Dollars : $ 
Preferred Start Date : 
Preferred End Date : 

All website advertisements must be paid in full within 30 days after being placed.
Please allow 2 weeks to place your ad on the webpage.
Advertising charges begin on date ad is placed on the webpage.
Email your Request for approval & an availability to : admin@TheMathWebSite.com
Please Include (1) This Form and (2) Your Ad Image - As Email Attachments.
...............................................................................................................
Below is For Office Use Only:
Ad Request Date : __________________________________
Ad Form Received Date : _____________________________
Ad Image Received Date :_____________________________
Ad Approval Email Sent Date: __________________________

Ad Payment Online : by Paypal / Visa / Mastercharge / Chargex / other
Date Payment Received : ____________________________
Payment Amount U.S. Funds : $ ______________________

Ad placed on Webpage 
Start Date :________________________________
End Date : ________________________________