Insertion Order Form

An insertion order template — formally book media by confirming the placements, dates, rates and total value with a publisher, ready for signature.

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Description

An insertion order is where a media buy becomes official. This insertion order form confirms exactly what’s being booked with a publisher — the placements, dates and rates — creating the signed record both sides rely on.

It captures the advertiser and campaign, the publisher or media owner, and the placements with their start and end dates, rates and units or impressions. It takes the rate basis and total order value, any special terms or targeting notes, the billing details, a PO number and an authorized signature.

Use it to formally book media once terms are agreed with a publisher. A clear, signed insertion order protects both parties and prevents disputes over what was booked. Customize the fields, add your branding, and embed it on your site or share a link in minutes.

Form fields

Everything the Insertion Order Form above collects — 13 fields across 2 pages, so you can see exactly what it captures before you make it your own.

Insertion Order

Advertiser / client
Short Answer
Campaign name
Short Answer
Publisher / media owner
Short Answer
Placements (placement, start, end, rate, units / impressions)
Table
Rate basis
Dropdown
Total order value
Short Answer
Special terms or targeting notes
Long Answer

Billing & Sign-off

Billing contact name
Short Answer
Email address
Email
Billing address
Address
PO number (if applicable)
Short Answer
Authorization
Consent
Authorized signature
Signature

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Template FAQs

Common questions about the Insertion Order Form — what it captures, when to use it, and how to make it your own.

What is an insertion order?

An insertion order (IO) is the agreement that formally books media with a publisher — confirming the placements, dates, rates and total value. It’s the signed record both the advertiser and the media owner rely on for exactly what was booked and at what price.

What should an insertion order include?

This form captures the advertiser and campaign, the publisher or media owner, the placements with their dates, rates and units, the rate basis and total order value, any special terms or targeting notes, the billing details, a PO number and an authorized signature.

When should you use an insertion order?

Once terms are agreed with a publisher and before the media runs. The insertion order turns a verbal or emailed agreement into a signed booking, so both sides are clear on the placements, dates and rates before anything goes live or gets invoiced.

Who signs an insertion order?

An authorized person on the advertiser or agency side, committing to the booking and the spend. The form captures the authorized signature, so there’s a clear record of who approved the media buy on behalf of the advertiser.

Why capture the rate basis on an insertion order?

Because the same budget buys very differently depending on the basis — CPM, CPC, a fixed placement fee. Recording the rate basis alongside the total makes the booking unambiguous, so there’s no dispute later about how the media was priced and what it delivered.

Is this insertion order template free to use?

Yes, completely free. Add or remove fields, adjust the placements and rate basis to fit your buys, and restyle it to your brand, then embed it on your site or share a link — no coding needed. A free Fun Forms account lets you collect signed orders.

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