Advertising Contract Agreement/LA VOZ LATINA

Company *

Address *

City *

State *

Zip *

Phone *

Contact Name *

Email address *

Ad Size *

Monthly Total

Number of Months

Total Cost

Above listed Company agrees to submit one or more ads with LA VOZLATINA. Please make checks out to LA VOZ LATINA for total above. New submissions are to be by the first of the month. LA VOZ LATINA REGIONAL agrees to promote and distribute each month for the months listed above.

Ad Color *

B&W

Color

Paid *

In Full

To be Billed

Company Authorized Signature *

Print or Email *

Credit Card Number

Expiration Date

Code

Name on Card

Address of Cardholder

Cardholder City *

Cardholder State *

Cardholder Zip *

This email address is being protected from spambots. You need JavaScript enabled to view it.
Phone:570-343-0927
PO Box 566
Dunmore Pa 18512
Cell: 570-881-2236

Date *

We look forward to working with you!

Website

Advertising Contract Agreement/LA VOZ LATINA

This email address is being protected from spambots. You need JavaScript enabled to view it.Phone:570-343-0927PO Box 566Dunmore Pa 18512Cell: 570-881-2236

We look forward to working with you!

This email address is being protected from spambots. You need JavaScript enabled to view it.
Phone:570-343-0927
PO Box 566
Dunmore Pa 18512
Cell: 570-881-2236