Monthly Advertising Fee: $100.00

 

Thank you for choosing to advertise on the NGHConnect Website Program.

Please note that a minimum of 3 months’ commitment is required to get your account set up.  We will require a payment for the first 3 months when you first enroll and thereafter, we will bill your credit card on a monthly basis.  After 3 months, you will be on a month-to-month basis and you may cancel your advertising at any time with written notice to be received by the 15th of the prior month.

Email Address:
Name
Street:
City:
State/Province:
Zip Code/Postal Code:
Country/Region:
Phone:
Website (if any):
Note: The fees for the subsequent months will be charged on the 28th of the prior month of advertising. Cancellations must be in writing and must be received by the 15th of the prior month advertising.
I would like to begin my advertising on (Month/Year):
Credit Card Type:
Card Holder Name:
Credit Card Number:
Expiration Date (mm/yy):
CVV Code:
The CVV Number ("Card Verification Value") on your credit card or debit card is a 3 digit number on VISA®, MasterCard® and Discover® branded credit and debit cards. On your American Express® branded credit or debit card it is a 4 digit numeric code.
If your credit card billing address is different from the one supplied above, please list it here:
*Ads are received on a first-come-first-served basis, this policy will apply to those of you who are practicing out of the same city (there is a 10 mile radius limit, exceptions may be made for very populated cities). If you have a website, we require that you place a link to the NGH on your website. We reserve the right to accept or decline advertising applications submitted. Terms and Conditions may be subject to change.
Please fill out this section with the characters provided:
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