Print Form by clicking on the “printer” icon on your browser or click “File” “Print” from your menu.
- 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: ____________________________  2nd E-Mail: ___________________________

Mailing Address (if different): _________________________________________________

Monthly Membership Fees (Includes 1st Class postage USPS)

 

1 Month $

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 as Premium Delivery)

$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 as Premium Delivery)

$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 as Premium Delivery)

$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 _________

= $_________

PREVUEPROMO.com

Grand Total

=$____________

 

Payment Method: (  ) Check or Money Order   (  ) Master Card   (  ) Visa   (  ) Amex   (  ) Discover
(  ) Please Bill My Credit Card Monthly Until Further Notice

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: _____________