NLA Ride Premium Listing Payment Form

NLARide Featured Listing & Advertising Payment Form

Complete the form below to purchase your Featured listing and/or advertisements on NLARide.com.
Name*

First NameLast Name
Email*
example@example.com
Company*
Which promotional opportunities would you like to purchase?*

Featured Listing - $199/yearBanner Ad - $650 for 1 location/year (additional fees for additional locations apply)Profile Ad - $450 for 1 location/year (additional fees for additional locations apply)
How many total locations would you like to place your banner ad in (can select up to 12)?*
First location for banner ad = $650, each additional location selected = an additional $150
Banner Ad Form Calculation
How many total locations would you like to place your sidebar ad in (can select up to 12)?*
First location for banner ad = $450, each additional location selected = an additional $100
Sidebar Ad Form Calculation
Ad Location #1 (City, State or City, Country if non-U.S.):*
Ad Location #2 (City, State or City, Country if non-U.S.):*
Ad Location #3 (City, State or City, Country if non-U.S.):*
Ad Location #4 (City, State or City, Country if non-U.S.):*
Ad Location #5 (City, State or City, Country if non-U.S.):*
Ad Location #6 (City, State or City, Country if non-U.S.):*
Ad Location #7 (City, State or City, Country if non-U.S.):*
Ad Location #8 (City, State or City, Country if non-U.S.):*
Ad Location #9 (City, State or City, Country if non-U.S.):*
Ad Location #10 (City, State or City, Country if non-U.S.):*
Ad Location #11 (City, State or City, Country if non-U.S.):*
Ad Location #12 (City, State or City, Country if non-U.S.):*
Total Calculation
Total Amount
Upload banner or sidebar ad:

Browse Files
Banner ad - 1280px x 160px. Sidebar ad - 410px x 500px Cancelof

Total Amount Due

USD

Credit Card

First Name

Last Name

Credit Card Number

Security Code

Expiration Month

Expiration Year

Billing Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

Should be Empty:

NLARide Featured Listing & Advertising Payment Form