QVC

2009 Cross-Channel Program Entry Form

Run 100 or more QVC cross-channel spots each month for either 6 or 12 months during 2009,* and we'll send your system up to $1,000 in QVC gift cards (see brochure or contact your ASM/QVC representative for details). Plus, run our spots for at least 6 months and your system will be eligible to win the Grand Prize Party!

Please fill in the information below, print this form and fax to 484.701.1350.

Your Insertion Plan - Please check off the months you will run spots below.

Jan     Feb     Mar     Apr     May     Jun

Jul      Aug     Sep     Oct     Nov     Dec

System Name:

System Address/PO Box:

City: State: Zip:

Number of Subscribers:    Spot Format:

Contact Name:

Title:

Phone: - -    Ext:    Fax: - -

E-mail:

Signature: ___________________________________________ Date: ____________

*Spots must run from 9am to midnight local time on any of the following networks: A&E, ABC Family, Bravo, CNN, CNN Headline News, Discovery Channel, DIY, Fine Living, Food Network, Hallmark Channel, HGTV, Lifetime, Oxygen, Style, TBS, The Weather Channel, TLC, TNT, TV Land, USA, WE. Affidavits due monthly to qualify. Affiliates who have a monthly promotional obligation to QVC as part of their affiliation agreement are ineligible to participate in this promotion.

Print this form and fax to 484.701.1350. Thank You!

            


For ASM/QVC use:          System ID #: ______________          Date: ______________          Gift: ______________