BINGHAMTON UNIVERSITY

ADVERTISING DISTRIBUTION SERVICES

Organizations making applications for ADS should complete Section 1 only and send it along with two (2) sample pieces for review to: ADS, Binghamton University CMS, P.O.Box 6000, Binghamton, NY 13902-6000. Campus Mail Services (CMS) Phone: 777-2914  Fax: 777-6920

SECTION I: TO BE FILLED OUT BY REQUESTING ORGANIZATION

A. Name and address of Organization

 

 

Contact Person

 

 

Phone: (     )

Fax: (     )

e-mail:

B. Name & address of Mailing Agent (if other than in A)

 

 

Contact Person

 

 

Phone: (    )

Fax: (    )

e-mail:

C. Requested Date of Mailing: __/__/__                       D. Number of pieces for Distribution: ____________

SECTION II: TO BE COMPLETED BY CAMPUS MAIL SERVICES AND
RETURNED TO REQUESTING ORGANIZATION

A. Sample Piece Review

                      Acceptable      ________
                      Unacceptable  ________                           Reason: ______________________________________

B. Signature of Reviewer: _________________________________

C. Distribution to Students:  All ______ Partial  _______

D. Rate/Piece: $________                     E. Total Pieces for Mailing: _______                   F. ADS Fee: $_______

G. This distribution will be the _________ of the current academic year.

Submit this form and check for ADS fee in advance or on delivery of mailing to Campus Mail Services. Checks should be made payable to:   BU IFR 90846

SECTION III: STATEMENT OF MAILING
TO BE COMPLETED BY CAMPUS MAIL & MESSENGER SERVICES

A. Date Mailing Received: ___/___/___                                B. Time: ________ a.m/p.m

C. Total Pieces Received: __________                                   D. Date of Distribution: ___/___/___

E. Authorized Signature: _________________________________________   Date: ___/___/___