Summary: Please complete the Banner Ad and Sponsorship Registration form. All submissions are confirmed.

Upon receipt, you will be contacted by a LifeInsurancenet Representative. General Terms and Conditions are provided below for your review.

Contact Information:

Name:

Title:

Company Name:

Address:

City / State / Zip:

Country:

Phone:

Fax:

E-Mail:

Bill To:

Agency Information:

Name:

Title:

Company Name:

Address:

City / State / Zip:

Country:

Phone:

Fax:

E-Mail:

Contract Information:

Start Date:

End Date:

Impressions Requested:

File Type:

Web Address Link for Banner Ad/Sponsorship:

Production Information:

Production Contact:

Phone:

Send Statistics to (e-mail):

Additional Comments:

General Terms and Conditions:
By submitting advertising for publication by LifeInsurancenet, each advertiser and advertising agency agrees to the following general terms and conditions:

1. Acceptance of advertising is subject to space availability upon receipt of signed contract by LifeInsurancenet.
2. Changes or cancellations in orders must be made in writing and received by LifeInsurancenet before the closing date.
3. Payment in full is due within 30 days of the "start" date of advertiser's ad.
4. LifeInsurancenet will have the right to hold advertiser and/or its advertising agency jointly and severally liable for monies due and payable to LifeInsurancenet for advertising which advertiser or its agent ordered and which was published and displayed.
5. LifeInsurancenet will provide advertiser with additional impressions, should LifeInsurancenet fail to provide the guaranteed number of impressions.
6. LifeInsurancenet is not obligated for under-delivery due to delays caused by advertiser and/or its agency. All frequency discounts are based on the advertiser and/or its advertising agency fulfilling their frequency commitment.
7. Advertisers and/or its advertising agency who do not fulfill their monthly volume requirement will be shortrated to the appropriate earned level.
8. In order to exercise the right of renewal, advertisers must notify LifeInsurancenet in writing 30 days before the termination date.
9. Advertisements are accepted upon the representation that the advertiser has the right to publish and display ad contents. The advertiser agrees to indemnify and hold LifeInsurancenet harmless against any expense or loss by reason of any claims arising out of online publication and display.
10. LifeInsurancenet reserves the right to reject or cancel any advertisement space reservation or position commitment at any time.
11. LifeInsurancenet will not be liable for any costs or damages if for any reason it fails to electronically publish and display an advertisement. In no event will LifeInsurancenet be liable for any damages, consequential or otherwise, in excess of the amount paid for the advertisement, as a result of any mistake in the advertisement, or for any other reason.
12. LifeInsurancenet is not liable for delays in delivery and/or non-delivery due to any condition beyond the control of LifeInsurancenet affecting production or delivery in any manner.