Telecom Insert Request

If you need to request an insert, please complete the following form and click submit. If you have any questions, please contact Telecom AMS.

Name:
E-mail:
Company Name:
Transmit Date(s):
All Exchange or Select Insert:
If Select, Specify Select Criteria:
Station Select Insert Set To Pull From (For NISC Use Only):
If Select, Approximate Number of Customers to Receive Insert:
Brief Description of Insert:
Will NISC be Arranging Printing of These Inserts:
If Yes, List Your Company Insert Contact:
Estimated Date of Inserts Arriving at NISC:	Note: To ensure timely completion of your billing, we ask that your inserts arrive at NISC five days prior to your transmit date.
What Would You Like Done With Extra Inserts:
General Comments: