Name
School
School Address
City/State/Zip
Phone
E-mail Address
Programs
Special Delivery Instructions
If you are placing a General NIE order, please fill in the following information. If you have additional non-delivery days for the Complete Roster of Fall Sponsored Programs, Complete Roster of Spring Sponsored Programs or individual programs you have ordered, please use the space provided for non-delivery dates:
Start/End Dates to
Days of Delivery S M Tu W Tr F
Number of Newspapers (minimum of 5)
Non-delivery Dates
Billing Contact (only necessary for General NIE)
Billing Address (only necessary for General NIE)
Billing Phone (only necessary for General NIE)