AirCheck Order Form

85 N.E. Loop 410, Suite 620 - San Antonio, TX 78216
6575 W. Loop South, Suite 605 - Bellaire (Houston), TX 77401

(210) 342-5900 - San Antonio (713) 661-9979 - Houston

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ORDER COVERAGE

Complete Form:
Items below in red are required in order to submit form.
Market:
Station/Affiliate:	ABC (KSAT, KTRK, WFAA, KXXV)		CBS (KENS, KHOU, KTVT, KCEN)
(Check all that apply)	NBC (WOAI, KPRC, KXAS, KCEN)		FOX (KABB, KRIV, KDFW)
	WB (KHWB, KDAF)		TEL (KVDA, KTMD, KXTX)
	UNI (KWEX, KXLN, KUVN)		OTHER / RADIO (SPECIFY BELOW)
Newscast Time:	5-7am	7-11am	11am-1pm	4-6pm
(Check all that apply)	6-7pm	9-10pm	10pm-Midn.	Other (Specify)
Broadcast Dates
beginning:
ending:
Story Topic:
Details/Keywords



Service Type:
Name:
Company:
Address:
Address 2:
City:			State:	Zip:
Phone:			example: 210-555-1212
Fax:			example: 210-555-1212
Email:

Please verify all information before submitting form. AirCheck personnel may not be able to respond to your request if information is incomplete or missing. You should receive a response from one of our staff within one working day.

©2003 Pinnacle Video Group, Inc.
85 N.E. LOOP 410, SUITE 620 SAN ANTONIO, TX 78216 Phone (210) 342-5900 __ Fax (210) 341-8553 email:	6575 W. LOOP SOUTH, SUITE 605 BELLAIRE (HOUSTON), TX 77401 Phone (713) 661-9979 __ Fax (713) 661-9973 email:

We Accept: