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Insertion Order Template

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Insertion Order Template

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Created by:


Insertion Order

This insertion order has been entered into between [Sender.Name] (Publisher) and [Client.Name] (Client) as of agreement created date.

Client Information:

Company Name: [Client.Company]

​Company Address: [Company.Address], [Company.City], [Company.State][Company.Zip]

Company Point of Contact: Contact Name

Phone: [Client.Phone]      

Email: [Client.Email]

Website: [Website.URL]

Agreement Date: [Date]

Advertisement Information

The Client’s listed Point of Contact will be responsible for the delivery of all needed information pertaining to this insertion order.

The advertisement shall begin placement on begin date and shall conclude on end date.

All advertisement specifications are as follows:​


The agreed price for such placement is total price.

All funds shall be paid via money order, cash, check, or credit card. All checks should be made payable to:

Entire Agreement

This insertion agreement serves in its entirety as the complete agreement between the Client and Publisher and shall supersede any and all prior written and verbal agreements as so.

Any and all modifications to this agreement shall be documented in writing and signed by both parties.

The Client represents that it has full power and ability to enter into this insertion order  and fulfill all duties within.

The Client is the rightful owner of all materials included copyrighted material provided to the Publisher during this agreement.

All materials contained within this agreement including the advertisement will not infringe or break any applicable laws or regulations.

​The Client will hold the publisher harmless of any loss, damage or injury, without limitation.

Likewise, the Publisher agrees to indemnify and hold the Client harmless without limitation.​


The Publisher may at any time terminate this agreement without notice upon any failure to pay by the Client.

Furthermore, breach of any section of this insertion order will be grounds for immediate termination.

Upon termination all funds will become due and this agreement will cease.

Governing Law

Any and all legal proceedings that may take place as a result of this insertion order will be under the jurisdiction of publisher state.

Prior to taking legal action the Parties agree to seek mediation in an attempt to solve any disagreements.


The Parties acknowledge receipt of this insertion order as well as an understanding of all terms and conditions contained within.









Insertion Order Template

Used 5,364 times

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