Please print this form out, complete and mail to the following address.

ROUTE 66 PULSE

FREE ADS AVAILABLE, MUST:

*Run 1 week at the time *Cannot be of commercial nature *Submit ads verbally (315.858.5858), via fax (315.858.2615), or can mail in the form below. Mail must be received by the 20th of each month.

CLASSIFIED AD FORM
Mail To:
Mercury Media Group, 140 Main Street,
Richfield Springs, NY 13439 (315) 858-5858
Must Be Pre-Paid
Private: First 20 words $24.00 Commercial: First 20 words $26.00
40 cents each additional word
1. 2. 3.
4. 5. 6.
7. 8. 9.
10. 11. 12.
13. 14. 15.
16. 17. 18.
19. 20. Over 20 words attach sheet
NAME___________________________________________________________
ADDRESS________________________________________________________
_________________________________________________________________
PHONE__________________________________________________________
ISSUE DATES TO RUN__________

PAYMENT:

CASH________________ CHECK________________#__________________