799 Camarillo Springs Road • Camarillo, CA 93012-8111 Phone: (805) 445-8881 • Fax: (805) 445-8882

Please Fill Out, Print, Sign and Return One Copy.
Date			Bill to: Agency. Client.
Company Name
Insertion Order.		Contract.	Revision.
(SAM) Specialty Automotive		(IAPA) Import Automotive Parts & Accessories
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Please Print Name
Signature			Date
Address
City			State	Zip
Phone			Fax
Advertising Agency Information (if applicable).
Please Print Name
Signature			Date
Address
City			State	Zip
Phone			Fax
Agency Contact			Ad Enclosed. Ad to come.
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Advertising must be prepaid unless credit is established with publisher. Combination discounts available with IAPA and SAM magazines. The above schedule of space is placed in accordance with the terms and provisions of our rate card and which automatically shall become part of this agreement.