Arizona Choices Exposition Payment Form

For a printable PDF version, click here

Exhibit Booth Fee $ _____________

Program Guide Ad $ _____________

Web Page Ad $ _____________

TOTAL DUE $ _____________

Deposit $ _____________ 50 % of Booth Fee*
+ Payment in Full for Ads.
(*Note: See Discount Dates For Details)

Balance $ ______________

Check, Cash or Money Order Enclosed:

$_____________
Or, You May Pay With Your:
MasterCard, VISA, Discover, American Express (Please Circle Type)

Card # _____________________________________

Expiration Date: _____/_____/_____

Last 3 Digits on Reverse of Card __________

Authorized By- Name as it appears on Card ________________________

Also, if applicable, please charge this Card for my balance when due.

Signature of Cardholder _______________________ Date __________

 


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