Electronic Sign Reservation Form

Electronic Sign Advertising Application
Applicant Contact*
Date*

MonthDayYear
Date
Contact Email*
example@example.com
Phone Number*
Organization/Business*
Not for Profit?*

YesNo
Business Address*
Number of Days requested*
List Dates Requested*
Input the message you want displayed (15-18 Characters per line):
Line 1
Line 2
Line 3
Line 4
Line 5
Special Requests
Special Requests
Applicant Printed Name*
Signature*

Clear
Fees

Religious institutions with facilities in the 19473 zip code serving Schwenksville Borough, Civic Organizations, and the Perkiomen Valley Library at Schwenksville are permitted One Free Message per month that is permitted to run for three days and are considered Non-Profit Organizations for all other messages.
Day General      Non-Profit Organization
1    $30.00       $20.00
2    $45.00       $30.00
3    $60.00       $40.00
4    $75.00       $50.00
5    $90.00       $60.00
6    $105.00     $70.00
7    $120.00     $80.00
8    $135.00     $90.00
9    $150.00     $100.00
10 $165.00     $110.00
11 $180.00     $120.00
12 $195.00     $130.00
13 $210.00     $140.00
14 $225.00     $150.00
Additional Per Diem -15 $ 10 additional Per diem thereafter up to 30 days
Fee
Paid by Check
Cash
Should be Empty: