Example

Insertion Order
ACCOUNT NAME: AMBITIOUS GAIN LP
ACCOUNT ADDRESS: SUITE 2, 5ST. VINCENT STREET, EDINBURGH, EH3 6SW, SCOTLAND, UK

Website: ClickAdilla.com
Run dates: ```actual date```
Terms: Flat Rate

Advertiser’s information
Name and Surname:
Payment method: Credit Card
Number of CC: **** **** **** ____
Expiration date: __/__
Name and surname on the CC: _______

I am, ```Name and Surname```, agree to charge balance of the account ```account on
ClickAdilla``` on ClickAdilla.com from Credit Card number ```**** **** **** ____``` and agree,
that all of the payments to ClickAdilla.com Advertising Network are approved by me and non-
refundable.

With my signature below I am authorized to enter into this agreement on behalf of advertiser
and agree with all of the terms.

Advertiser’s signature: Date:

__________________ _________________

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