Capt'n Tom's Artworks
Ad Space Lease Submission Form
Print this form from your printer, fill out completely and send with your payment To:
CAPT'N TOM'S ARTWORKS
111 North Stuart Street
Baltimore, Maryland,USA 21221
Please Print:
Your Name ______________________________________________________________
Street _________________________________________________________________
City, State/Province Zipcode __________________________________________________
Phone Number _____________________________________________________________
Email Address _____________________________________________________________
Company Name _____________________________________________________________
Name Of Website __________________________________________________________
URL __________________________________________________________
Banner Location/Text Wording (Limit 10 Words) __________________________________
__________________________________________________________________________
AD SPACE DESIRED: (Circle One)
100 X 600 Pixels..... $100/month............. Term/90 Days............. Pay This Amount $300.00
80 X 290 Pixels.......... $50/month............. Term/90 Days............. Pay This Amount $150.00
60 X 190 Pixels.......... $25/month............. Term/90 Days............... Pay This Amount $75.00
Text Ad...................... $15/month.............. Term/90 Days............... Pay This Amount $45.00
TOTAL ENCLOSED: (U.S. Dollars Only) _________________
Payable To: Capt'n Tom's Artworks
_______________________________
Your Signature: |
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________________________
Today's Date: |
THANK YOU for advertising with Capt'n Tom's Artworks!!!...
You will receive confirmation via email,... Capt'n Tom Ruley