Union Reporters

FULL NAME

First NameLast Name

BILLING ADDRESS

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

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 NameLast Name

COMPLETE COMPANY NAME

COMPANY PHONE NUMBER

BUSINESS ADDRESS

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

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

E-mail

Location (include all states and counties)

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