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Business Name: ______________________________ Contact Person: _____________________________
Address: ___________________________________ City: _________________ State: ___ Zip: ________ Email:_________________________ Website: _________________________
Phone: ___________________ Work Phone: ___________________ Fax: __________________
Signature: _____________________________ Date: ______________
By signing above I agree to content and cost contained in this contract and have read the User Agreement.
Make check /money order payable to MAIN or include your credit card information.
Card Number: __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ Expiration Date: ____ / ____
Amount authorized to charge: $ _________ Card Holder Signature: ____________________________
I am also interested in MAIN's other services! Please contact me about :
□ Website Hosting □ High-speed Internet
□ Mailing Lists □ Other web services
Notes
Underwriting Contract
Rate Package (13 weeks):
□ Platinum $400 □ Gold $300 □ Silver $125
Show Sponsorship:________________________________________
Thom Hartmann Program □ $400 /1 month □ $1,000/13 wks
Democracy Now! □ $200 /1 month □ $500/13 wks
□ News, Cultural, Public Affairs ($50/1 month or $125 /13 wks)
□ Music ($50/1 month or $125 /13 wks)
Start date: _____________ Quantity: _________ Total Due: _____________
Payment received: ____________________ Initials: _________
□ Check □ Cash □ Visa, MC, Discover
Office use only
34 Wall Street, Suite #407
Asheville, NC 28801
828.255.0182 * www.main.nc.us
75 Haywood St.
Asheville, NC 28801
828.258.0085 * main-fm.org
Modified July 28, 2011