AHRMA ~ Web Ad Submission Form


CREDIT CARD PAYMENT SUBMISSION INSTRUCTIONS:
Please complete the form below to include your credit card information and then hit the "Submit" button at the bottom for processing.


CHECK PAYMENT SUBMISSION INSTRUCTIONS:

If you prefer to send in your payment via a check, please complete the information below, "Print It" and then hit the "Submit" button at the bottom to send your ad text to us for processing.  Then mail the form with your payment to the address on the form.

OR
Just print the form and hand write the information in and mail it with your payment to the address on the form.

WEB AD RATES
 3 months $75.00

6 months $140.00 ($10 discount)

9 months $210.00 ($15 discount)

12 months $280.00 ($20 discount & Best Value!)

 

Additional Graphic Insert Charges:

Company Logo                           $25.00

Additional images/graphics           $15.00 each
Company Name:
Contact Person:
Mailing Address:
City: ST:   ZIP:
Phone w/area code:
Email:
Website:

Payment Options:
 Check -

 Payments must be received in advance.
Mail a check payable to AHRMA to the following address:
                           AHRMA
                           309 Buffalo Run
                           Goodlettsville, TN 37072
 OR
select credit card option below:

Credit Card Type:  

Credit Card Number:
Expiration Date? (example -1/10, Month/Year)
CV Code on Back of Card: (last 3 or 4 digits on the back right side of card)

Please select which Web Ad Package you would like to purchase?

Will you be adding a Company Logo?

Please email Company Logo to Tami@TRPro.com.

Will you be adding additional graphics?

Please email additional graphics to Tami@TRPro.com.

Please type your ad content below?

Additional Comments:

Please "PRINT" your form before submitting by clicking the printer icon to the right ~

Thank you for Supporting AHRMA!

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