This Is A Printable Form
Peruvian Digest
3095  Burleson-Retta Rd.
Burleson, TX 76028
817-426-0944 - FAX: 817-447-9711

Advertising Space Contract

RUN AN AD YOU ALREADY HAVE
Please run, again, my ad that appeared in the ____________________ issue of Peruvian Digest
[ ] Please bill me     [ ] Please charge to my Credit Card you have on file.

NEW AD
Please reserve ___________________________ (size of ad) ad in the
________________________(date of issue) edition of Peruvian Digest.
Please run the ad ___________ times.

Enclosed is the:
[ ] color separations
[ ] camera-ready ad 
[ ] rough draft( ____ with photo ____ no photo)
[ ] Please Fax me a proof at ____________________

Space Cost $___________________                    

Color Separation $___________________                    

TOTAL: $___________________          

Please charge to my [ ] Visa [ ] Mastercard [ ] AMEX [ ] Discover
Number: _______________________________ Expiration Date ______________________

Signature:______________________________

If you choose to run the ad more than once, we will bill you each time it runs. You do not have to pay the full amount up front.

Please print the following information:

Name _____________________________________

Ranch Name _______________________________

Address ________________________________________________

City/State/Zip ____________________________________________

Phone: ____________________________E-mail _________________________