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Title *
First day of sale *
Format *

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Title *
First day of sale *
Format of the Ad-Special *

Agency *
Street, No. *
Zip Code *
City *
Phone *
Fax
E-mail
 

Advertising medium *
Week of publication from *
Number of placements *
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Color *
Printing material delivery per
 

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Name *
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Collection authorization
Account No.
Bank (please provide exact description)
Bank code
Wire transfer
Banking Account: Dresdner Bank Offenburg (BLZ 680 800 30)

Account No.: 7 234 120 00

Agency *
Street, No. *
Zip Code *
City *
Phone *
Fax
E-mail
 

Advertising medium *
Week of publication from *
Number of placements *
Format *
Printing material delivery per
Text for word ads *
 

* = Required
Please note that this information cannot be transmitted in encrypted form at this time.
Name *
Street, No. *
Zip Code *
City *
Collection authorization
Account No.
Bank (please provide exact description)
Bank code
Wire transfer
Banking Account: Dresdner Bank Offenburg (BLZ 680 800 30)

Account No.: 7 234 120 00

* = Required
Title *
Publication from *
Format *
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