|
Name of Business:
|
|
|
Address:
|
|
|
City:
|
|
|
State:
|
|
|
Zip Code :
|
|
|
Contact Person:
|
|
|
Phone:
|
|
|
Fax:
|
|
|
Date:
|
|
|
E-mail:
|
|
|
Advertisements in the Souvenir:
|
|
Front & back page:
|
|
$2,500: Back full page in color
|
$1,500: Front Inside full page in color
|
|
$1,000: Back Inside full page in color
|
|
|
Inside the Souvenir:
|
|
|
$800.00: Inside full page in color
|
$500.00: Inside half page in color
|
|
$400.00: Inside full page in b/w
|
$250.00: Inside half page in b/w
|
|
$150.00: Inside quarter page in b/w
|
$100.00: Banner Advertisement
|
|
Any Comments:
|
|
|
|
|
I here by authorize the India Culture Center to Charge $ to my Credit Card
|
|
Name as on the Card:
|
|
Credit Card #: Exp.
|
|
Master Card Visa American Express Discover Card Dinner's Club
|
|
Please check if credit card billing address same as business address.
If different, please write the address in comments.
|
