UC&M Request Form


	Phone: (717) 872-3586 Fax:(717) 871-2009
Duncan Alumni House 2nd Floor Millersville University, P.O. Box 1002 Millersville, PA 17551-0302	Requester's Name:
	Department: Email:
	Phone Number: Fax Number:
	Today's Date: Delivery Date By:

Communication Objectives:

Cost Center # (SAP): Check here if cost is covered by

Amount Budgeted (if known): $

Job is part of the marketing plan

Delivery Location: Building Room:

Paid Advertising Services: (Media Buying Required)
Advertising placement requires variable lead times. UC&M will work with you to determine timelines.

Magazine (print)

Outdoor (billboards)
Start date End date

Newspaper (print)

Reserve through
Run Dates:

Radio
Start date End date

Program (print)

TV
Start date End date

Marketing & Communications Services

Website

Invitation/Envelopes: Quantity

Flyer (8.5x 11): Quantity

Program: Quantity

Poster (11x17): Quantity

Banner: Quantity

Brochure: Quantity

Large format display: Quantity

Bound booklet : Quantity

Other: Please specify

Check here if mailing required:
Check here to request a consultation with UC&M regarding:

Upon submitting this form, you will receive an automatic receipt from University Communications & Marketing. Your request will be processed within 24 hours.

For supporting paperwork and materials , please send to Deb Miller by way of inter-office mail.

For status inquiry, please call 717-872-3586.