Ad Order Form - Rev1
Ad Order Form - Rev1
Ad Order Form - Rev1
AD ORDER FORM
Organization Name _________________________________________________________________________
E-Mail _______________________________________________________________________________________
Technical Information
Ad Size: 1/2 Page (7.5” W x 4.75” H) Full Page (7.5” W x 10” H) New Ad? Repeat Ad?
Payment Information
Payment Amount: $200.00 (1/2 Page) $350.00 (Full Page) Other: $ _________________
Payment Method: Check (to HSA-UWC) VISA Master Card (add 3% for credit card)
Notes ________________________________________________________________________________________
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ACLC Chicago y 7450 N. Sheridan Rd. y Chicago, IL 60626 y 773-274-7441 (Kunihiro Sagisaka)