ACCEPTED AND AGREED TO:
______________________________ | ______________________________ |
Client’s Signature | Mailing Address |
______________________________ | ______________________________ |
Printed Name | City, State, ZIP |
______________________________ | ______________________________ |
Date | Phone Number |
______________________________ | ______________________________ |
Co-Client’s Signature (if applicable) | E-mail Address |
_____________________________ | _____________________________ |
Printed Name | FAIR COVERAGE |
______________________________ | ______________________________ | Date | Date |
Fair Coverage Dot Com
P.O. Box 2922
Culver City, CA 90231-2922