Support Westbrook Republican Town Committee

Purchase an Ad for your company in our 2022 Holbrook Dinner Tickets - Event Date is April 28, 2022 - Water's Edge Inn and Resort

Attach your ad copy, original ad or business card to this form. If you would like to submit your ad copy via email (preferred); please send as a pdf. attachment to hruppenicker@westbrookrepublicans.org and return this form with payment only. Please put Holbrook Dinner Ad Book in the subject line.

Please note: Low-resolution images will appear noticeable grainy or blurry when reproduced. Please call with questions regarding ad format, etc (860)391-5166 (Harry

Use Your DonorID (optional)

Ad Book Space

x $250

Full Page Ad - Premiere

Full Page 6.5” H x 4.5” W Includes Table Sponsorship Sign (more)

x $200

Full Page Ad

Full Page 6.5” H x 4.5” W (more)

x $100

Half Page Ad

Half Page 3.25 H” x 4.5” W (more)

x $50

Quarter Page Ad

Quarter Page 3.25” H x 2.25” W (more)

x $35

Business Card

Business Card Size (more)

Phone

Name

First

Last

Address

Street Address

Apt.

City

State

Zip

Comments

COMPANY / ADVERTISER NAME Is This Purchaser a Business Entitiy? Is Purchase Being Made from the Account of a Sole Proprietorship? If Yes, Name of Business or Name of Sole Proprietorship Contact Name Street Address City / State / Zip Credit Sale to Westbrook RTC Member

Card Number

Exp. Date

CVC

ZIP / Postal

Your card code is incomplete. Your card code is invalid. Your card code is missing. Your expiration date is incomplete. Your expiration date is missing. Your expiration date is in the past. Your card number is incomplete. Your card number is invalid. Your card number is missing. Your billing ZIP is incomplete. Your billing ZIP is missing.

Bank Routing Number (9 digits) Bank Account Number (4-17 digits)

Bank Account Type

Business Personal

Checking Savings Checking Savings

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This contribution is not made from the general treasury funds of a corporation, labor organization or national bank.

I am not a foreign national who lacks permanent resident status in the U.S., nor do I personally contract with the federal government for personal services or the sale of goods, land or buildings.

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