INFORMATION & RESOURCE DISPLAY
ORDER FORM
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.
Payment Terms Choose One:
Pay Now For 5% Discount With Electronic Check
Send to Address Listed Above
Pay Now For 5% Discount With Credit Card
Street # of Billing Address:
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 Greater New Britain 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.
*Pricing Does Include $49 Processing Fee