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Vendor Resource Form
Avada Support
2022-11-21T15:56:55-05:00
Business Name
(Required)
Contact Name
(Required)
First
Last
Contact Phone Number
(Required)
Contact Email Address
(Required)
Billing Address
(Required)
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
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Northern Mariana Islands
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Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Category
(Required)
There will be a maximum of 5 vendors per category. Management will confirm availability upon submission of request. If category is not available, funds will be refunded.
Check for Resident Discount
I am a Resident
Must provide proof of residency for verification.
$150 Annual Advertising Rate
(Required)
Price:
note renewals will be due in January
Resident Discount
(Required)
Price:
Business Card Image
(Required)
Accepted file types: jpg, png, Max. file size: 1 MB.
File must be optimized for size and quality, maximum 1MB in size.
Website
For hotlink
Total
Credit Card
American Express
Discover
MasterCard
Visa
Supported Credit Cards: American Express, Discover, MasterCard, Visa
Card Number
Expiration Date
Month
Month
01
02
03
04
05
06
07
08
09
10
11
12
Year
Year
2024
2025
2026
2027
2028
2029
2030
2031
2032
2033
2034
2035
2036
2037
2038
2039
2040
2041
2042
2043
Security Code
Cardholder Name
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