Ad Order Form - Rev1

Download as pdf or txt
Download as pdf or txt
You are on page 1of 1

8th Year Anniversary Banquet – Chicago

AD ORDER FORM
Organization Name _________________________________________________________________________

Mailing Address _____________________________________________________________________________

City _______________________________________________________ ST ____ Zip _________________

Telephone _____________________________ Ext _________ Fax _____________________________

E-Mail _______________________________________________________________________________________

Contact Name _________________________________ Title _____________________________________

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?

Is camera-ready art provided? ‰ Yes ‰ No Do we need to design ad? ‰ Yes ‰ No

Is photo included? ‰ Yes ‰ No Photo format: ‰ Hard copy ‰ Computer file

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)

Exact Name on Credit Card __________________________________________________________________

Credit Card No. ………………………………………… Expiration Date …………


Processing Information (Office Use Only)

Order Date ____________________ Order Received By ________________________________________

Payment Received Date ____________________ Check No. ______________

Notes ________________________________________________________________________________________

______________________________________________________________________________________________

______________________________________________________________________________________________

______________________________________________________________________________________________

PLEASE FAX TO 773-274-9860. ORDERS MUST BE RECEIVED BY MAY 20, 2008.

ACLC Chicago y 7450 N. Sheridan Rd. y Chicago, IL 60626 y 773-274-7441 (Kunihiro Sagisaka)

You might also like