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Sandi's Tryst Magazine Personal Ad Form |
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Section A
Full Name (His): __________________________ Full Name (Hers): __________________________ Address: ___________________________________ Address: ___________________________________ City: ______________________________________ Province/State: _________ Postal/Zip:______ Telephone Number: (_____) - ________________ |
Personal advertising must be submitted on this form to be accepted by the Publisher. Please fill it in completely and sign at the bottom. Please refer to the fee schedule and enclose all applicable fees with your ad copy. Ads are published on a space-available basis and run for a minimum of two issues. If you would like to know the first issue in which your ad will appear, just send an extra $10.00 with this form, and we will send you an advance copy of the magazine containing your ad. The information in Section A is strictly confidential and is for our forwarding and accounting purposes only. It is never given out. We do not rent, loan, or otherwise offer our mailing lists to anyone. I further certify, by signing below, that I am not an officer of the law using correspondence for the purpose of entrapment. |
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For Office Use Only
Code Number : _______________________________ Special Requests : ____________________________ |
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| Section B List Ad As Non-Smoking [_] Block Face in Photo [_] Block Eyes in Photo [_] List City as: _________ List Ad as:_______________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ WARNING! Anyone submitting personal ad copy and/or photos other than of the person or persons represented will be subject to monetary damages and/or criminal prosecution. By signing below I/we declare under penalty of perjury that the enclosed information is true and correct. All ad insertion requests Must be on this Personal Ad Form Type and Placement of Ad. Preferred Heading for our/my ad is: ______________________________________ Please insert our/my ad as a direct contact ad using the above address, phone number &/or email address Please insert our/my first name(s) in direct contact ad (yes/no) : ________________ Please issue us/me a TrystBox # and forward our/my mail to the above address (signature) __________________________________ Please mark our/my ad as Non-Smoking Block Face in Photo Block Eyes in Photo
Payment Method: __Certified Cheque __Money Order __Cash __Visa __M/C __Amex Card # _____________________________________ Expiry Date: __________ Signature Below We/I the undersigned, hereby represent that We/I are eighteen years of age or older and that we have read and agree to the terms as written in the small print on the How To Place A Personal Ad page. Signatures: His ______________________________________ Hers ______________________________________ Send completed form to: Tryst Magazine, 99 Bronte Rd., Suite 69, Oakville, Ontario, Canada, L6L 3B7 This form is to be completed entirely for a personal ad. Signing this form also states that you agree to the terms and conditions as stated in the How To Place A Personal Ad page. |
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