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Media Authorization Form <br /> <br />client: {Client Name} <br />project: {Campaign Name} <br />date: 11/30/18 <br /> <br />The purchase of all media will adhere to the following projected breakout, and any <br />adjustment(s) to projected spend will be reflected in monthly budget maintenance reports. <br /> <br />Gross media budget (if applicable) <br /> <br />Commission/fee (if applicable) <br /> <br />Client net (total) <br /> - <br /> <br />- <br /> <br />$- <br /> <br />See Exhibit 1 for further details. <br /> <br />Clean (ಯAgencyರ) is authorized to act on behalf of {Client Name} (ಯClientರ) in the research, <br />planning and placement of media. The Agency shall be solely liable for payment of all media <br />invoices if the Agency has been paid for those invoices by the Client. Prior to payment to the <br />agency, the Client shall be solely liable. <br /> <br /> <br />Clean Design {Client Name} <br /> <br /> <br /> <br />Authorized by: Authorized by: <br /> <br />Print name: Print name: <br /> <br />Title Title <br /> <br />Date Date <br /> <br /> <br />a:6601SixForksRoad,Suite400,Raleigh,NC27615 p:919.544.2193 w:cleaninc.com <br />DocuSign Envelope ID: 206F38A0-4744-45EF-9C6B-B0194CE2775B