GSB MEDIA
REMOTE REQUEST FORM
Account Executive:
Todays Date:
Advertiser's Name:
Station Requested:
Date and Times of Broadcast (ex. 1pm-3pm):
Talent Requested:
Talent Fee:
On-Site Contact:
Contact Phone:
Location (include address):
Equipment other than broadcast equipment needed:
Brief description of event/broadcast:
Event Facebook page or website URL:
Event Contact Name:
Event Contact Email:
Event Contact Phone:
Attach additional information & copy for remote here:
clear field
for office use only
Approved by Operations:
Approved by Sales:
Talent assigned:
Date of Approval:
new