INFORMATION & RESOURCE DISPLAY
ORDER FORM
Silver Package
Gold Package
$744.00
$544.00
Account Information:
This will only be used to set up your account. We will have someone contact you seperately regarding what you'd like on your ad.
Company Name:
Contact Name:
Street Address:
City, State, Zip:
Contact Phone:
Email:
Choose A Package:
Payment Terms Choose One:
Bill Me (Due Net 30)
Pay Now For 5% Discount With Electronic Check
Send to Address Listed Above
Billing Address:
City, State, Zip:
Attention:
Pay Now For 5% Discount With Credit Card
Bank Name:
Bank City & State:
Routing #:
Account #:
Check #:
Name On Check:
Name On Card:
Card #:
Expiration Date:
Street # of Billing Address:
CSV #:
Zip Code of Billing Address:
Purchase Agreement**:
I verify that I have authorization to purchase this ad space on behalf of the company listed above. I understand that this purchase is a one-time fee for one full year on the Lawton-Fort Sill Chamber of Commerce Information & Resource Display. I understand my ad year will begin 30 days from day of this purchase. I give Profile Display permission to immediately process my order in the fashion indicated above. I understand that this purchase is non-cancelable.
X____________________________________________
Authorizor's Signature
Date_______/_______/_______
Profile Display Incorporated profiledisplay@profilemediagroup.com 888-545-9853
**Participation is on a first come, first served basis. If the package you chose is no longer available we will contact you before processing your order.
(580) 354-7337
*Pricing Does Include $49 Processing Fee