Co-op Ad Form

CO-OP AD FAX FORM
Please print out & fill out this form and fax it to us at 916 933-8516 to participate in any of our co-op ads.

Property Name:

Cardholder Name:
(As it Appears on Your Card)

Your Email Address:

Full Address:
(Where your Credit Card Statement is Mailed To)

Which Ad(s)?:
(5% Discount for trying 2 or more at once - check all you want to participate in)

Boston: Bay Windows bw 3 Ad Run Half Size- $150

Boston: Bay Windows bw 3 Ad Run Full Size- $250

Chicago: Windy City Times bw 3 Ad Run Half Size - $150

Chicago: Windy City Times bw 3 Ad Run Full Size - $250

New York: New York Blade bw 3 Ad Run Half Size - $175

New York: New York Blade bw 3 Ad Run Full Size - $300

San Francisco: Bay Area Reporter bw 3 Ad Run Half Size - $150

San Francisco: Bay Area Reporter bw 3 Ad Run Full Size - $250

Instinct Magazine: 1 month color Ad - $400

Girlfriends Magazine: 1 month color Ad Half Size - $99

Girlfriends Magazine: 1 month color Ad Full Size (Custom) - $175

5% Discount Offers:

Girlfriends or Instinct Magazine: If you chose the Girlfriends or Instinct ad above, check here if you want to run this ad for six consecutive monthly issues. We'll take 5% of the total cost off the last ad (your card will be billed once a month for six months for this 6-ad run).If you chose the Girlfriends ad, we'll also give you an ongoing banner ad on the Girlfriends website.

Any Local Co-op Ad(s): If you chose any of the local ads above, check here to be included in the Spring, Summer, and Fall runs of these same ads as well. That's three consecutive issues each, for a total of twelve issues during the year. We'll take 5% of the total cost off the last ad (your card will be billed once a quarter for these ads).

Text to Use in Ad:
Up to 10 words (Full-Size ads only)

Credit Card #:

Credit Card Expiration Date:

Signature:

We'll use your property name, toll free (if applicable) phone number, and website url as they appear on your Purple Roofs directory listing. If you'd prefer to use a different phone number, url, etc, please indicate so here:

By signing and faxing back this form, I authorize Mongoose on the Loose Web Design dba Purple Roofs to charge my credit card for the amount(s) selected on this order. Credit card charges will appear on my statement as Mongoose 916 933-8514.

Please fax this order form to us at 916 933-8516, and email us a hi resolution picture and/or logo to use to wheretostay@purpleroofs.com. If you have any questions about this order, call us at 916 933-8514.