Silver Package
Gold Package

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:


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:

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 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. 

                                              Authorizor's Signature
Profile Display Incorporated          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.