KIOSK PAVILION INQUIRIES
Name:
Title:
Company Name:
Company Address:
City:   State:   Zip:
Country:
Telephone #: Fax #:
Website:
Email:

Please include a description of your product or service (up to 150 words)
1. 2. 3.

Please email us or send us pictures (3" X 5") that can be included with your information.

The introductory cost of ONE banner is $600 per year or $1100 for a two year term.

YES, I want to purchase a banner/webpage for a term of one year two years at the cost of $600 for a one year term and $1100 for a two year term.

Our contract term will begin on (Enter start date)
An invoice will be sent to you immediately.

Terms: Net 30 days. Please note that your banner & webpage will be placed only after payment is received.