Program Book Advertisement Purchase Form

Program Book Advertisement Purchase Form

Make checks/money orders payable to: Lumbee Regional Development Association Attention: Natascha Tilson P.O. Box 68 Pembroke, NC 28372
Contact Information
Contact Person

First NameLast Name
Title / Position
Company or Organization
Mailing Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
City
State
Postal Code
Daytime Phone
Please enter a valid phone number.Format: (000) 000-0000.
Fax No.
Please enter a valid phone number.Format: (000) 000-0000.
Email Address
example@example.com
Website
Ad Size Selection
My Products
prevnext( X )
FULL PAGE grayscale or black/white(7.5” x 10”) Name

$400.00 Quantity



HALF PAGE grayscale or black/white (7.5” x 4.75”)
$250.00 Quantity



QUARTER PAGE grayscale or black/white – (3.5” x 4.75”)
$150.00 Quantity



BUSINESS CARD grayscale or black/white (3.5” x 2”)
$100.00 Quantity



Subtotal

$0.00

Tax

$0.00

Total

$0.00
Special Instructions
Advertisement File Upload

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Payment Details
Payment Method
Purchase Order Number
Total
Make checks/money orders payable to: Lumbee Regional Development Association Attention: Natascha Tilson P.O. Box 68 Pembroke, NC 28372
Agreement
Agreement
Name of Authorized Representative

First NameMiddle NameLast Name
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Internal Use Only
PO Amt.
PO #
PO Date Received

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Sponsor
Amt. Received
Check #
Payment Type

Other
Date Received

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
AD COPY RECEIVED Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Payment Methods

Fastlane Checkout

Choose from one of the PayPal options to make your payment.

Contact Info

Payment Info
Should be Empty:

Program Book Advertisement Purchase Form

Contact Information

Ad Size Selection

My Products*

Payment Details

Make checks/money orders payable to: Lumbee Regional Development Association Attention: Natascha Tilson P.O. Box 68 Pembroke, NC 28372

Agreement

Internal Use Only

Payment Methods

My Products