APPLICATION  FOR  AIRTIME

BIRACH  BROADCASTING  CORPORATION

21700 Northwestern Hwy * Tower 14 * Suite  1190 * Southfield,  MI 48075

http:// www.birach.com           Tel: 248-557-3500   Fax: 248-557-2950

 

 Applying for airtime at radio : ______________________________________________________

Program name: ___________________________________________________________________

Director name: ____________________________________________________________________

Address: __________________________________________________________________________

Telephone:  work _______________________                  home ____________________________

                          fax ______________________                 pager ____________________________

                         SS # _____________________                    DL # ____________________________

Preferred  Day's

MONDAY  -  TUESDAY  -  WEDNESDAY  -  THURSDAY  -  FRIDAY  -  SATURDAY  -  SUNDAY

Hour's

1st choice ________________ 2nd choice ________________ 3rd choice________________

 

Remarks:

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                             date                                                   signature

FILL IN THE REQUESTED INFORMATION AND FAX THE APPLICATION TO FAX NUMBER 248-557-2950