Antiquing the Internet Electronic Submission Form

Your Internet ad can be 50 words or less. Payable prior to publication by check, money order or credit card. Payments for all E-mailed or faxed ads must be recieved no later than 5 business days after ad submission. (See pricing chart below)


ANTIQUING THE INTERNET PRICE LIST
3 MONTHS
$39.00		 6 MONTHS
$69.00		 12 MONTHS
$123.00
Your ad will be published in both Southeastern Antiquing & Collecting magazine and on the Southeastern Antiquing & Collecting Website


(* Required Fields)
Name:*
Business Name:
Position:
Mailing Address:*
Address Line 2:
City:*
State:* Zip:*
Phone:*
(No Dashes)
Fax:
E-mail Address:*
Credit Card:
(Click one only)		 Visa
MasterCard
Credit Card#:
Exp. Date:
Ad Heading:*
Seen in BOLD face

Type your web site description below up to 50 words.*

Months Desired
For Publication		 January
February
March
April
 May
June
July
August
September
October
November
December

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