DISH NETWORK CO OP ADVERTISING CLAIM FORM DISH Network by pluggtwo

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									                           2004 DISH NETWORK CO-OP ADVERTISING CLAIM FORM

DISH Network Retailer Name___________________________________________Retailer #_____________
Contact Name_____________________________________________________Date____________________
Address__________________________________________________________________________________
City_________________________________________State_______________________ZIP______________
Phone_________________________FAX_____________________E-mail____________________________
A. Total advertising expenditure devoted to DISH Network $__________________
B. Divide expenditure total (Line A) by two (2) $__________________
DISH Network will pay up to 50% (amount indicated in Line B above) of your advertising expenditures not to exceed total co-
op advertising accrued. Please review the Co-op Advertising Guidelines prior to creating advertisements or submitting a claim.

Please ensure the following documentation is included with each claim:
• Accurately completed Co-op Advertising Claim Form.
• Original pre-approved advertisement (not applicable for Hibbert P-O-P items):
   • Print Advertisements: All tear sheets including the periodical name and the date the ad was run.
   • Radio/Television Advertisements: Notarized script and affidavit from station stating when ads were
   run.
   • Direct Mail/Alternate Distribution: Original ad, original distribution and production receipt and the
   postage receipt (3602 report form United States Postal Service for individual pieces mailed, or
   original invoice from distribution company if multiple pieces mailed).
   • Fairs and Trade/Home Shows: Copy of contract (does not have to be original) and a minimum of 2
   different photographs.
   • Billboards/Signage: A minimum of two different photographs of DISH Network display.
   • Mall Kiosks: A minimum of two different photographs of DISH Network kiosk (photos must show
   entire mall kiosk), copy of contract/rental agreement from mall and the address of primary storefront
   location.
• Original media, DISH Network bandwidth or Hibbert invoice: Copies will not be accepted (except for
   Fair and Trade/Home Shows).
• Current Co-op Advertising Pre-Approval Form (if necessary).
• A copy of the initialed ad sent in for pre-approval and reviewed by the Co-op Advertising Department
   (not applicable for Hibbert P-O-P items).
To expedite payment, please include one claim form per invoice. Any claims submitted without the proper documentation
will be considered incomplete and will not be reimbursed. Multiple claims for the same advertisement will not be accepted.
Violation of this policy may result in loss of privilege to sell DISH Network. Please keep a copy of all claims and supporting
paperwork. If you purchase equipment through a distributor, please submit claims to that distributor. All claims must be
submitted and postmarked no later than 45 days following the accrual period.
Please send claims to DISH Network at the following addresses or to your Distributor:
Through U.S. Postal System                                     Via Overnight Shipments
DISH Network Retail Services Department                        DISH Network Retail Services
Attn: Co-op                                                    Attn: Co-op
PO Box 6629                                                    9601 S Meridian Blvd
Englewood, CO 80155                                            Englewood, CO 80112
Retail Services Use Only:
Date Received________________________
Signature___________________________________________________
Date Submitted_______________________
Signature___________________________________________________

								
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