Radio Cooperative Advertising, Claim Form

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Advertising Invoice Breakdown

(YYYY-MM-DD)

(Including any taxes)


Radio Ad Spending Breakdown

Enter the total number of radio advertisements for each product line. Please indicate if non Salford products are represented and how many per advertisement. If all commercials are for the same product line and no other products are represented you can enter "1" for the quantity of commercials.

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0
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0
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0
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0
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0
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0
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0
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Including 56 Series applicators, ST Series applicators and PathFinder carts.

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Attach Invoice and Script including affidavit

Drag and drop files here or