Local Channel Ad Submission

Name *

First

Last

Your Organization

Email *

Confirm Email

Phone *

Billing Address *

Address Line 1

Address Line 2

City

State

Zip Code

Date Ad to Start *

Date Ad to End *

Notes

File Upload

Click or drag files to this area to upload. You can upload up to 5 files.

Upload any attachments, photos, event fliers, etc. here:

Confirmation *

By checking this box, I confirm that I am requesting Corn Belt Telephone advertise the above mentioned information on their Local Channel 15. I understand that I will be billed $5/week per 15 second slide.