119 W. Sherman, Hutchinson, KS 67501 - Ph: 620-664-6297 - Cell Ph: 620-200-1381 - Fax: 620-664-6265

** Up to 30 words per ad is $65 per quarter or $130 per year

** Up to 100 words per ad is $115 per quarter or $230 per year

Company or Business Name:
 		Member Name:
Email:
 		How many words do you desire your ad to be?:
30    100
Place your text here:
 
   
Payment Option:
Per Quarter    Per Year 		 
 
Form of payment:
Credit Card    Sending Check 		 
If by Credit Card, check card type:
Visa     Master Card     Discover
 
Credit Card Number:
 		 
Name on Credit Card:
 
Expiration Date:
 
CVV:
Image Verification (required):
(enter code shown below)