SCAN AD Order Form

Name
Organization/Company
Address
City
State
ZIP
E-mail
Phone (Pls include area code)
FAX (Pls include area code)
Please Choose Ad Size(s)
Premium Positions (Full Units Only)
Color



Listing Copy (see rate card)
Additional Information
Ad Cost (see rate card)
Total Due
Permissions



To complete your reservation, please click the "RESERVE AD" button below.

Finalize it by mailing your payment to 4411 Bee Ridge Rd.,#195, Sarasota FL 34233

To order an optional web site banner ad for ads less than 1/4 pg, Click here