Ad Request for Chamber Web Site

Note: Please include the items noted under "What to Submit to the Chamber" when you drop off or mail this form.

Date/Time Received __________________ by _____________ (For office use only)

Name of Business:

Name of Owner:

Mailing Address of Owner:

Phone Number:

Email Address of Owner:

Ad Size Desired (Please circle one):

• Small Banner ($150.00 - 3 months)
• Double High Banner ($240.00 - 3 months)
• Double Wide Banner ($240.00 - 3 months)

Ad Location Desired (Please specify page on web site):

1st Choice:

2nd Choice:

3rd Choice:

Web Page Advertising Reservation Receipt

Name:

Date:

Time: