Classified Ad Submission Form

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First Name *	Please let us know your name.
Last Name *
Mailing Address *
City *
State *
Zip Code *	Invalid Input
Phone *	Invalid Input
Email *
Ad Text *		5 words per line or 26 characters max.
	PHOTO AD
Photo Ad	Invalid Input	6 Consecutive Days for $20.00
Photo Ad Text	Invalid Input	15 Words + Phone or Email
	ADDITIONAL OPTIONS
Ad Options	Bold ($1.50 one time fee, specify below) Underline ($1.50 one time fee, specify below) Italics ($1.50 one time fee, specify below) All Bold ($3.00) Reversed ($5.00) Garage Sale Index ($1.50) - Deadline 12:00 Noon on Wednesday (Offered April - September only) Invalid Input
Special Instructions	Invalid Input
	RATES
Ad Rates *	3 Days: 3 lines = $6.00, each additional line $2.00 6 Days: 3 lines = $9.49, each additional line $3.16 12 Days: 3 lines = $18.45, each additional line $6.15 24-30 Days: 3 lines = $33.83, each additional line $11.28 Invalid Input	*Run 24 days, get 6 days FREE - Other rates available on request
Start Date: *	Invalid Input
End Date: *	Invalid Input
	Credit Card Information
Name on card *	Invalid Input
Card Type *	Invalid Input	Choose one
Card Number *	Invalid Input
Expiration Month *	Invalid Input	Choose one
Expiration Year *	Invalid Input	Choose one
Card Verification Value (CVV) *	Invalid Input
Security	Invalid Input
	After your form is received you will be contacted by e-mail with a price quote from a classified ad representative. Transactions will occur 2 hours after price quote is given or after customer confirmation, whichever comes first. Should you have a question regarding your transaction, contact us immediately. Phone: (937) 592-3060 x132 or x110 - Fax: (937) 592-4463 Email: classifieds@examiner.org The Bellefontaine Examiner publishes Monday through Saturday

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