LOCAL COVERAGE VIRGINIA

Phone (703) 618-2941

Fax (703) 815-1770
Your Real Estate Flyer & Delivery Company Est. 1997

Name_______________________________________________ Company ______________________________________________

Company Address ___________________________________________________________________________________________
Office Phone_____________________________ Cell _______________________________Home___________________________
Graphic Designers Name__________________________ Cell ______________________ Home __________________________
Flyer Property Address ________________________________________________________________ Broker Open:

Yes

No

**** Website - www.localcoverageva.com ****

Email your flyer to localcoverageva@verizon.net. The deadline is 3 pm on Friday. We accept the
following formats: Publisher, Microsoft Word, Power Point, or Adobe PDF format.
Please fax a copy of the flyer and the order form to the above number.
We are not responsible for font errors if we do not have a copy of the flyer.

DELIVERY SCHEDULE: All areas are delivered by Sunday 5pm.

Step 1: Circle VA Distribution Areas
Areas
# of Agents
1) Alexandria/Old Town .............................. 745
2) Burke ........................................................... 355
3) Centreville/Chantilly/Fair Oaks ............. 600
4) Fairfax/Annandale .................................... 575
5) Falls Church/Arlington/ .......................... 725
6) Great Falls................................................... 240
7) Leesburg ..................................................... 306
8) Manassas ..................................................... 285
9) McLean ....................................................... 810
10) Reston/Herndon ........................................ 690
11) Springfield/Franconia/Kingstowne ....... 380
12) Sterling/Country Side/Ashburn ............. 325
13) Vienna/Oakton/Tyson .............................. 675
14) Woodbridge/Dale City/Lakeridge ......... 435
Total # of Agents for all areas. ..7146
Total Number of Copies Circled
________

Step 3: Itemized Charges

$0.000

$0.00

1. ______________ x _______________ = $ ____________

Total # of copies
cost of paper
2. Add 5% VA Sales Tax

= $ ____________

.05

3. Add Cost of Delivery

$9.00 per area if we do the printing
$14.00 per area if you do the printing
$100 special rate for all areas if we do the printing
***Save $26.00!
0
_____________
x _____________ = $ ____________
# of areas
cost of delivery

4. Total Cost (add steps 1 - 3)

$0.00

= $ ____________

** All prices are subject to change without notice.

** We reserve the right to pick a color if one is not chosen.
**Or substitute a color if out of stock.

Step 2: Circle Paper Color & Size

Step 4: Payment Method

Paper

We accept the following Credit Cards: (please circle one)

Visa MasterCard American Express
Account Number:

White

Ink
Black

Paper Size and Cost

8.5 x 11
.035

8.5 x 14
.04

Expiration Date:

Pastel
Black
.04
.05
Tan, Salmon, Pink ,Orchid, Lilac, Ivory, Green, Buff,
Goldenrod, Cream, Cherry, Canary, Blue, Turquoise
Brite-Hues Black
.05
Ultra-Lemon, Ultra-Pink, Ultra-Orange, Ultra-Lime,
Ultra-Fuchsia, Sun-Yellow, Sea-Blue, Yellow, Gold
Double Sided Copies

.02 add to cost

CVV Code:

Billing Address
_____________________________________________________
_____________________________________________________
Zip Code
Cardholder Signature:

** There is a $25.00 charge back fee for any return credit card payments.
****************************************************************
For office use only:
Auth # __________________________ Ref #______________