Ad Order Form

Company Name: *
Contact Name: *
Mailing Address: *
City:
State:
Zip Code:
Phone: *
Fax:
Email Address: *
Ad Sizes:
1 1/4 x 6inch Banner Ad
1 x 2inch Sidebar Ad
1 x 2inch Sidebar Ad with one (1) Page Website Ad
1 1/4 x 6inch Banner Ad with one (1) Page Website Ad
Your No Spammer...Right?:
*

All contracts are for one (1) full year and are billed on anniversary date.
Payment arrangements can be made.   Please contact the Chamber @ (760)326-2050.

Once this form is received we will be in contact with you for the information on your ad and payment arrangements. If you choose to not to use this form,  but still would like to purchase an Ad on our website you may contact us by phone or stop by and see one our friendly office personnel.

* Content shall not contain objectionable pictures, information or wording of any kind. Needles Chamber of Commerce will not be responsible for any leads generated, regardless of their outcome. We also reserve the right to decline any advertisement of that sort.