Underwriting Contract Online payments accepted through PayPal. "*" indicates required fields Organization InfoName of Organization* Contact Name* First Last Address* Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone*Email* Website Package and ContentAnnouncement A KLZR representative will contact you to work out the wording of your announcement. Package Fee Contract Length Versions Cost Per Spot* Basic One $175 6 months 1 version $0.48 Basic Two $300 12 months 1 version $0.41 Premium One $400 12 months 2 versions $0.55 Premium Two $600 12 months 4 versions $0.82 *ApproximateSelect Package* Basic One - $175 Basic Two - $300 Premium One - $400 Premium Two - $600 All packages will air your announcement twice per day between 6am and 6pm, 7 days a week for the duration of the contract.Proposed Start Date MM slash DD slash YYYY Package Total Upon submission of this form, you will be redirected to PayPal for payment of this amount.Select Payment Method* Pay online with PayPal or credit card Pay by mail with a check Payment MethodPayPal CheckoutCredit Card American ExpressDiscoverMasterCardVisaSupported Credit Cards: American Express, Discover, MasterCard, Visa Card Number Expiration Date Security Code Cardholder Name Signature*CAPTCHA
