Free 52805.pdf - Indiana

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STATE OF INDIANA MEDIA REQUISITION
Please return completed form to Stephanie Genrich ­ [email protected] ­ Phone 232-1012 Date: State Agency: State Agency Contact: Phone: E-Mail: Campaign: P.O. Number: RADIO TV OUTDOOR TRANSIT NEWSPAPER MAGAZINE WEB THIRD PARTY Length of Spot: Length of Spot: Size: Size: Size: Size: # of Colors: # of Colors: Media Budget: Creative Agency: Creative Agency Contact: Phone: E-Mail: Flight Dates: Geographic Target Areas:

Please describe ad types: Please describe:

IN-STORE/RETAIL Please describe: PRIMARY TARGETS Demographic Audience Profile SECONDARY TARGETS Demographic Audience Profile CAMPAIGN OBJECTIVES

VALUE-ADDED REQUESTS ­ PLEASE DESCRIBE

OTHER COMMENTS/SPECIAL INSTRUCTIONS

Traffic information attached on State of Indiana Traffic Requisition Form Traffic information to be provided later Traffic information not required

SF 52805 (R / 10-08)