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Sponsor Agreement

Print Edition (Date/Market):

Account Name/Corporate:

Listing Name:

Listing Address:

Listing Phone:

Online Listing Fax:

Online Listing Tollfree:

Online Email Link:

Online URL/Link:

Print Ad Size:

Print Ad Location (only 1 topic per ad):

Listing Topic/Service(s):

Print Costs:

Web Enhanced Ad Market(s):

Web Enhanced Ad Topic(s):

Web Listing Market(s):

Web Listing Topic(s):

Total Additional Web Enhanced Ad(s) Ordered: Total Web Enhanced Ad Costs:

Account Contact Information (for Retirement Connection use only) Agreement Type:

Primary Contact: Name/Company: /

Direct/Cell: Email:

Graphic/Ad Contact: Name/Company (if different):

Direct/Cell: Email:

Artwork:

Payment Information

Sales tax will be applied as required by state and local tax law.

Payment Type:

Billing Terms:

Billing Contact: Email: Phone:

Billing Address: State: Zip:

Notification Preference:

Total:

Leave this empty:

Your legal name

Your email address

Please Confirm full name and signature.

Draw your signature with your mouse, tablet or smartphone Clear

I agree that I am and I agree this is a legal representation of my signature for all purposes just the same as a pen-and-paper signature

I agree that I am and I understand this is a legal representation of my signature

Timestamp

Audit

April 6, 2017 9:41 pm PDT

Sponsor Agreement Uploaded by Amy Schmidt - amy@retirementconnection.com IP 73.69.12.209

April 13, 2017 1:34 pm PDT

Document owner info@retirementconnection.com has handed over this document to amy@retirementconnection.com 2017-04-13 13:34:14 - 67.5.215.69