Name:________________________________________________
Business______________________________________________
Address______________________________________________
City, State, Zip_________________________________________
Phone (_________)
_____________________________________
E-mail Address_________________________________________
Advertising
package to be purchased - Please check one
_________ 1-3 month advertising is $27.00 per month
(number of months purchased ________)
_________ 4 month package is $99.00
_________ 8 month package is $ 175.00
___________
12 month package is $240.00 (savings of ver $80.00)
The start date will be the 1st day of the next
month after the application is received and will go the duration of the
number of months purchased.
Please e-mail a jpg logo of your company after sending
this information. Please send to:
News@CampusFireSafety.com
______________________________________________________
Total Cost of this order? $
________________
Method of Payment (check
one)?
_____Check Enclosed (form
must be mailed not faxed)
_____Credit Card
______________________________________________________
Credit Card Authorization
_____ Amex _____
Visa _____ MasterCard _____ Discover
Card Number:
_________________________________
Exp. Date:_________________
Zip Code: ___________
Name on
Card:________________________________
______________________________________________________