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Website Banner Ad Registration

(Please complete all fields)

Please complete this form. Email the image submissions, as well as any questions to RCA at administrator@rca-usa.org.

Company Info

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)

Company Zipcode (required)

Company Phone (required)

Company Fax (required)

URL to link Banner Ad to (required)

Banner Image

Specifications:

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.

Payment Details:

 One Month: $200 Two Months: $400 Three Months: $540 (10 percent discount) Six Months: $960 - 20 percent discount)

Credit Card Type

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)

Billing Zipcode (required)

Acceptance (Signature Required)

 

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