Patsy's On-line Advertising Payment Form

Ad size     Full page - B/W Full page - color Half page - B/W Half page - color Vendor Listing - 4 issues (1 yr) - $35 Vendor Listing - 1 issue - $10 Spotlight page - 1/2 page B/W only $65 Spotlight Page - B/W $100 Spotlight Page - Color $300 Crowning Corner - B/W $35 Centerfold - Color $900 Inside Front Cover - Color $700 Inside Back Cover - Color $600 Other

Other Description     

Name        

Company Name (if any)           Website address (if any)    

Address         (If using a credit card, please use your billing address for that card)

City           State       Zip

Phone with area code     

Email      

Type of Card   Visa MasterCard American Express Discover

When paying by Paypal, please put X's in the Card # box below......then send your Paypal payment using beckyweyant@hotmail.com   for your payment.

Card #

Name as it appears on card  

Expiration Date 

Security Verification Number  

When paying by Paypal, please use beckyweyant@hotmail.com   for your payment.

 

      Total Payment $