Advertiser Payment Form AYN Advertisement Payment Form Please provide payment based on the agreed upon AYN Proposal. Once the payment is received, AYN will implement the next steps to begin advertising on the AYN network. Contact InformationContact Name* First Last Email* Phone*Agency or Advertiser InformationAgency or Advertiser Name*Agency or Company Address* Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Name of Adv. Campaign*Please provide the name of the Advertising Campaign/Sponsorship or Promotion with AYNStart Date of Campaign: Date Format: MM slash DD slash YYYY End Date of Campaign: Date Format: MM slash DD slash YYYY Total Cost of Advertising Campaign*The net amount of the agreed upon advertising/sponsorship proposal Payment Amount to AYN $0.00
