TV Cable's Public Service Announcement (PSA) Request Form

Please fill out detailed information below. This form will be submitted electronically to the TV Cable office(s) you select below. Submission of PSAs does not guarantee telecast.
Please Note: Required fields are identified in red .
You should fill in the required fields before submitting this form.

Name of Organization (To be aired on behalf of):



Address of Organization:

Street:
City:
State:
Zip Code:

Contact Information:
Name:
Daytime Phone:
E-mail Address:

PSA Information:
Please type in the public service announcement in the area below. Text PSAs are limited to 25 words. (We reserve the right to edit PSAs.)


Do you have any instructions or questions for us about this public service announcement?

Text PSAs need to be submitted at least 7 days prior to event and are subject to approval.

Requested date to start airing the PSA:


Requested date to stop airing the PSA (14-day limit):


Please check off the market(s) in which you would like your PSA to air. After your selection(s) have been made click on the submit button below:
Rensselaer/Morocco
Winamac/Star City/Bruce Lake

This will send your PSA to the location(s) you selected. Thank you!

If you have any questions, please contact TV Cable @ 800-621-2344