Advertiser Contract Ad Submission Deadline: June 30th, 2025 Business Name(Required)Representative Name(Required) First Last Physical Address(Required) Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Billing Address(Required) Same as previous Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Phone(Required)FaxEmail(Required) Advertising Sales Person(Required)If none, enter "none" or "N/A".Ad Selection(Required)Please choose the ad(s) you would like to purchase. Back Cover (Color) - Ad size: 8" W x 10.5" H Inside Back Cover (Color) - Ad size: 8" W x 10.5" H Front Inside Cover (Color) - Ad size: 8" W x 10.5" H Center Full Page (Color) - Ad size: 8" W x 10.5" H Center Half Page (Color) - Ad size: 8" W x 5.125" H Full Page (Black & White) - Ad size: 8" W x 10.5" H Half Page (Black & White) - Ad size: 8" W x 5.125" H Quarter Page (Black & White) - Ad size: 8" W x 2.4" H Business Card - Ad size: 3.785" W x 2.4" H Select AllAdd a Website Ad?(Required)NoYesAvailable only with the purchase of a display ad. This option puts your ad on the Heritage Highway Website.Hot Link Your Ad?(Required)NoYesAvailable only with the purchase of a display ad. This links your ad directly from our website to yoursBusiness Website(Required) Enter full link, including https://Shopper Guide Ad Price: Total Cost of AdPaid in full with this contract. Payment MethodPayPal CheckoutCredit Card American ExpressDiscoverMasterCardVisaSupported Credit Cards: American Express, Discover, MasterCard, Visa Card Number Expiration Date Security Code Cardholder Name EmailThis field is for validation purposes and should be left unchanged.
