Please complete this form. Email the image submissions, as well as any questions to RCA at administrator@rca-usa.org.
Company Name (required)
Contact Person (required)
Contact Title (required)
Contact E-Mail(required)
Website Address (required)
Month to begin sponsorship
Month to end sponsorship
Company Address (required)
Company City (required)
Company State (required) ---AKALARAZCACOCTDCDEFLGAHIIAIDILINKSKYLAMAMDMEMIMNMOMSMTNCNDNENHNJNMNVNYOHOKORPARISCSDTNTXUTVAVTWAWIWVWYABBCMBNBNLNTNSNUONPEQCSKYTASGUPRVI
Company Zipcode (required)
Company Phone (required)
Company Fax (required)
URL to link Banner Ad to (required)
Banner Image
RCA Members $200 per month, 10% discount for 3 months, 20% discount for 6 months - Sponsor information must be submitted in JPG or GIF formats only.(No animation, please) Size Specifications: Must be 468 X 60 pixels and file size should be under 20KB. A maximum of five ads will be displayed on a rotating basis at any given time. Payment must be received before the information is posted.
One Month: $200 Two Months: $400 Three Months: $540 (10 percent discount) Six Months: $960 - 20 percent discount)
Credit Card Type Select Card TypeMaster CardVisaAmerican ExpressDiscover
Name on Credit Card (required)
Card Number(required)
Expiration Date MM/YY format(required)
Should you want to pay by check contact RCA at administrator@rca-usa.org Please make checks out to Rural Cellular Association and send to: 805 15th St. Suite 401 Washington, DC 20005
Billing Contact (required)
Billing Title (required)
Billing Phone (required)
Billing Address (required)
Billing City (required)
Billing State (required) ---AKALARAZCACOCTDCDEFLGAHIIAIDILINKSKYLAMAMDMEMIMNMOMSMTNCNDNENHNJNMNVNYOHOKORPARISCSDTNTXUTVAVTWAWIWVWYABBCMBNBNLNTNSNUONPEQCSKYTASGUPRVI
Billing Zipcode (required)
Acceptance (Signature Required)
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