JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Sign me up for the Buy Local Book!
Please fill out the form below to let us know you're interested in being involved in the Buy Local Book
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Contact Name
*
Your answer
Business or Organization
*
Your answer
Address, City, State Zip
*
Your answer
Phone
*
Your answer
Email
*
Your answer
Website
Your answer
Advertising Selection (MEMBERS)
1/3 Page Ad ($340)
Full Page Story ($575)
1 Coupon ($190)
2 Coupons ($340)
3 Coupons ($440)
Profile - add on only ($50)
1 coupon and a 1/3 page ad ($450)
3 coupons and a 1/3 page ad ($650)
1 coupon and a full page story ($650)
Full page story and a 1/3 page ad ($875)
1 coupon, a full page story and a 1/3 page ad ($975)
3 coupons, a full page story and a 1/3 page ad ($1,200)
Advertising Selection (NON-MEMBERS)
1/3 Page Ad ($390)
Full Page Story ($625)
1 Coupon ($240)
2 Coupons ($390)
3 Coupons ($490)
Profile - add on only ($75)
1 coupon and a 1/3 page ad ($495)
3 coupons and 1/3 page ad ($695)
1 coupon and a full page story ($695)
Full page story and a 1/3 page ad ($925)
1 coupon, a full page story and a 1/3 page ad ($1,025)
3 coupons, a full page story and a 1/3 page ad ($1,250)
PAYMENT
*
I would like to pay over the phone with my debit/credit card
I will mail a check
PAYMENT DETAILS:
PHONE: Please call Calen at our office at 802-862-8347 and she'd be happy to take your credit card payment over the phone
MAIL: Please make your check out to VBSR and mail to 255 South Champlain St, Suite 11, Burlington, VT 05401
Submit
Clear form
Never submit passwords through Google Forms.
Forms
This content is neither created nor endorsed by Google.
Report Abuse
Terms of Service
Privacy Policy
Help and feedback
Contact form owner
Help Forms improve
Report