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- Fill in your information & sign your name at the bottom of this form.

- Mail or Fax the completed form to:

PREVUE PROMO, PO Box 1012, Euless TX 76039. Fax: 817-545-9009

Your Name: ____________________________________________________________________

Business Name Or Radio Call Letters: _________________________________________________

Shipping Address: ________________________________________________________________

City: ____________________________ State: ____________________ Zip: _________________

Phone: ( ______ )__________________________ Fax: ( ______ ) _______________________

E-Mail: ________________________________ 2^nd E-Mail: ______________________________

Mailing Address (if different):________________________________________________________

Monthly Membership Fees (Includes 1^st Class postage USPS)		1 Mo. $	x No. of Months	= Total Per Format
Format A (Pop/Top-40/Adult Contemporary/Alternative/Rock/AAA)
- Premium - Delivery 2 times a month: (Get your product faster than Standard service)		$47.90	x _________	= _________
- Standard - Delivery 1 time a month: (same # of CD’s per format a twice a month)		$42.95	x _________	= _________
Format B (Urban/Urban Adult Contemporary/CHR/Rap/NAC/Smooth Jazz)
- Premium - Delivery 2 times a month: (Get your product faster than Standard service)		$47.90	x _________	= _________
- Standard - Delivery 1 time a month: (same # of CD’s per format a twice a month)		$42.95	x _________	= _________
Format C (Country/Contemporary Country/Bonus Country/Request Country)
- Premium - Delivery 2 times a month: (Get your product faster than Standard service)		$47.90	x _________	= _________
- Standard - Delivery 1 time a month: (same # of CD’s per format a twice a month)		$42.95	x _________	= _________
ALL Music, All 3 Formats (SAVE!! Get ALL our product at a special price)
Premium Service at Standard Price (Delivery 2 times a month) You SAVE $14.85 per month		$128.85	x _________	= _________
PREVUE PROMO PO Box 1012, Euless TX 76039 Ph: 817-283-8683 / Fax: 817-545-9009		Grand Total		= _________

 Check or Money Order  Master Card  Visa  Amex  Discover

Acct. #

Name On Card: _______________________________________________ Exp.Date _____________

I hereby certify that I am a Professional DJ or that I represent a Radio Station (or other facility authorized to receive this product):

(Your Signature) X _______________________________________________ Date: _____________