INSERTION ORDER


VELISMEDIA information:				AFFILIATE information:
Company Name		VelisMedia Ltd.		Company Name			__________
Primary Contact		__________		Primary Contact Billing Contact			__________ __________
Email		__________		Email			__________
Address		Jabotinsky 7, Ramat Gan, Israel		Address			__________
Phone		+972-__________		Phone			__________
Fax		+972-__________		Fax			__________
Date issued		_________________		Effective Date			_________________
service description:
Subject to the execution of this Insertion Order and to affiliate’s full compliance with the General Terms and Conditions for affiliates (the “Terms”), VelisMedia will promote the Advertiser’s Creative via affiliate’s Publishers network (as such terms are defined under the Terms). These Terms shall govern all future and any future mutually agreed campaigns, unless otherwise agreed by the Parties in writing.
Campaign description:
Velis’ Advertiser	Pricing Type		Payout			Other characteristics		Payment Terms
								Net 30

By executing this Insertion Order, you acknowledge, represent, warrant and agree that: (i) You and the Affiliate’s Primary Contact indicated above are each a duly authorized representative of the Affiliate, each eligible and authorized to represent the Affiliate and to commit it to enter into this Insertion Order and to be bound by the Terms, and hereby make all representations and warranties herein on both your and Affiliate’s behalf. (ii) You have read and understood the Terms, you acknowledge that this Insertion Order and the Terms constitute a binding and enforceable legal contract between VelisMedia and Affiliate, and you agree to be bound by them and to comply with all applicable laws and regulations regarding Affiliate’s use of VelisMedia’s services. (iii) This Insertion Order and the Terms shall govern any and all future mutually agreed campaigns, unless as agreed otherwise by VelisMedia and Affiliate in writing (including by email exchange between VelisMedia’s and Affiliate’s Primary Contacts), or otherwise as set forth under the Terms.
Authorization:
VelisMedia Ltd. By: ________________________________ Signature: __________________________ Date: ______________________________					[Affiliate] By: ________________________________ Signature: __________________________ Date: ______________________________