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Name of Business:
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Address:
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City:
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State:
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Zip Code :
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Contact Person:
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Phone:
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Fax:
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Date:
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E-mail:
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Advertisements in the Souvenir:
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Front & back page:
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$1,500: Back full page in color
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$1,000: Front Inside full page in color
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$750: Back Inside full page in color
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Inside the Souvenir:
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$500: Inside full page in color
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$350: Inside half page in color
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$250: Inside full page in b/w
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$150: Inside half page in b/w
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Any Comments:
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I here by authorize the India Culture Center to Charge $ to my Credit Card
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Name as on the Card:
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Credit Card #: Exp.
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Master Card Visa American Express Discover Card Dinner's Club
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Please check if credit card billing address same as business address.
If different, please write the address in comments.
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