Blitzen' DFW Advertising Order Request

Please complete and submit the form below to confirm your interest in advertising with VIVE Lifestyle Network ("VLN") through its digital distribution (mobile LED billboard) campaign. Upon submission, VLN will issue an invoice within 24 hours, payment of which will secure placement.

Please indicate your position with the business/company.

Please provide the business billing address for invoicing purposes.

Please check types of advert(s) desired.

Please select your preferred exclusive 4-hour time slot. If requesting multiple 4-hour slots, please indicate preferences in 'Special Notes' below. Not applicable for non-exclusive 56-hour promotions.

Please advise should you have any specific requests and/or should you need to indicate the number of product placements.

I agree to VLN's Terms & Conditions.