INFORMATION & RESOURCE DISPLAY
ORDER FORM
Silver Package
Gold Package
$544.00
$344.00

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 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.