Union Reporters

FULL NAME

First Name Last Name

BILLING ADDRESS

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country

YOUR EMAIL ADDRESS

BUSINESS PHONE:

OTHER CONTACT NUMBER

AMOUNT OF PURCHASE

My Payment is for the following

SPECIAL BILLING INSTRUCTIONS

PLEASE READ THE LOA BELOW

BY ENTERING MY NAME IN THE BOX TO THE RIGHT, I AUTHORIZE PLANNMEDIA TO CHARGE MY CREDIT CARD/BUSINESS ACCOUNT THE AMOUNT OF MY PURCHASE. I UNDERSTAND I HAVE 72 HOURS TO CANCEL MY PURCHASE WITH PLANNMEDIA BY EMAILING MY REQUEST TO support@plannmedia.com I HAVE READ AND AGREE TO THE TERMS AND CONDITIONS OF PLANNMEDIA CANCELLATION POLICY.

YOUR REPRESENTATIVES NAME

NOTE: THE PROCESS FOR POSTING ALL LISTINGS IS UP TO 30 DAYS. PLEASE ALLOW THIS TIME FOR US TO BUILD AND POST YOUR LISTING/LISTINGS TO OUR WEBSITE.

WE ASK THAT IF YOU HAVE ANY PICTURES, LOGOS, SPECIAL VERBIAGE (etc.) THAT YOU WOULD LIKE US TO USE, SUBMIT THOSE TO support@plannmedia.com AS SOON AS POSSIBLE.

SUBSCRIPTION PLANS AND PACKAGES

Full Name

First Name Last Name

COMPLETE COMPANY NAME

COMPANY PHONE NUMBER

BUSINESS ADDRESS

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country

Add your URL (if you have your own website, we can link it to your listing)

E-mail

Location (include all states and counties)

Categories

Description of Products and Services (services provided)

Special Instructions

Description of Discount to Appear on Ad (not required)

Do you have any of the following social media? We can add them to your listing(s):
FACEBOOK, LINKEDIN, INSTAGRAM, TWITTER

Paste Facebook URL

Paste Linkedin URL

Paste Instgram URL

Paste Twitter URL

AMOUNT OF PURCHASE

Credit Card Information (Number, Expiration Date, CVV)

Name On Bank Account

Bank Name

Routing Number

Account Number

Confirm Account Number

Type of Accout

Signature

Clear

Chose A way to Pay

Pay by E-Check