Supplier
Media Order Form
Please complete all information and email signed order form to sales@vdta.com.
CONTACT INFORMATION
Company Name:
Contact:
Address:
Title:
City: Province/State: Postal Code: Country:
Email: Website:
Office Phone:
Contact for Billing:
Cell Phone:
Name: Phone:
Email:
Signature:
PROMOTION OR MEMBERSHIP
Check all that apply, and fill in issue and/or date information.
INSPIRE. AD: Send date
E-BLAST: Send date
VDTA.COM POST: Post date
Date:
SUPPLIER MEMBERSHIP: $800 Annually
You will receive your invoice(s) via email. Payment may be made through the link provided. All ads, eblasts, and posts must be paid in full before sent or posted.
