Mod&Alt Health Ad Form
Mod&Alt has 6 issues a year. Please read the Ad Rates at
Please give 2-3 business days for a confirmation and invoice. We will not respond to impomplete forms.
You or the name of your company *
Your answer
A 2-3 sentence description of your article.about your business, product or service. *
Your answer
Your email address so we can invoice you and provide links to submit your information. *
Your answer
Phone number *
Your answer
Ad Type *
For Covers Only- Please pick 2-3 possible issues for your ad. They are first come, first serve. Dates are for 2019
For 2-Page Spreads or Basic Ads- You can have your ads in multiple issues. We will invoice you for the total amount.
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service