Business Name:
Street Address:
City: State:
Zip:
Phone:
Email:

Billing Address:
City: State:
Zip:

Your Name:
Position:
Billing Contact:
Billing Phone Number:

I have chosen five (5) pages from the list above on which I would like to place banner ads, one banner per page. I agree to pay the sum of $295.00 per month for a period of one (1) year as indicated in my selection from the Advertising Period above. I agree to make my payment by the first day of each month for a period of eleven (11) months following my initial payment which shall accompany this Advertising Agreement.

I understand that this is a legal and binding contract. If payment is not made within 30 days of invoice date, Image Builders, at its option, may terminate the contract. In addition, advertiser/agency shall be liable to Image Builders for all attorney's fees and other costs of collection. Interest will accrue on any past due amounts at the rate of one and one-half (1 1/2%) percent per month, but not in excess of the lawful maximum. Image Builders shall have the right to hold the advertiser and/or its agency or agent jointly and severally liable for all amounts due.

By submitting this form, you agree that you are legally empowered with due corporate authority to enter into this Contract and agree to be bound by the Terms and Conditions of this contract.