YOUR BUSINESS INFORMATION

COMPANY*:
CONTACT NAME*:
FULL ADDRESS*:
PHONE*:
YOUR EMAIL*:

DECALS

HOW MANY REMOVABLE STATIC CLING DECALS DO YOU NEED FOR STORE?

HOW MANY MAGNETIC VEHICLE DECALS DO YOU NEED FOR YOUR SERVICE VEHICLES?

YOUR AD

(If you don’t have a Storefront, no problem. Instead of your address, put in the service area you serve.)

WRITE-UP YOUR AD HERE (5 LINES MAXIMUM)

COMPANY WEBSITE:

TYPE IN THE CATEGORY YOU WANT TO BE LISTED IN
CATEGORY:

YOUR REPRESENTATIVE

REPRESENTATIVE ID OR NAME*:

CARD TYPE:
VisaMastercardAmerican ExpressDiscoverDebit Card

CARD NUMBER:

BANK DRAFT

NAME OF BANK:
9 DIGIT ROUTING NUMBER:
BANK ACCOUNT NUMBER:
CONFIRM ACCOUNT NUMBER:

TOTAL AMOUNT TO BE CHARGED: $:

By hitting submit, I authorize the above amount to be charged to the Disabled Veterans of America. I understand it is for advertising on the Disabled Veteran’s website for an entire year from today’s date. I also will receive complimentary decals for my store and/or service vehicles.

Questions? Call 1 (800) 448-6610