DATE: _________________________________________________________________

NAME OF BUSINESS: ___________________________________________________

CONTACT PERSON: ____________________________________________________

ADDRESS: _____________________________________________________________

CITY: ______________________________STATE:__________ ZIP: _____________

PHONE: ________________________ E-MAIL:_______________________________

WOLVERINE PULLER CONTACT: _______________________________________
(THIS PERSON WILL BE CREDITED FOR THE YEAR END POINTS FUND)

SIZE OF AD:
BUSINESS CARD $100 _______________

¼ PAGE $250 _______________

½ PAGE $500 _______________

FULL PAGE $750 _______________

MAKE ALL CHECKS PAYABLE TO: WOLVERINE PULLERS, INC.

MAIL ALL FORMS AND CHECKS TO:
KAREN ALLEN-WOLVERINE PULLERS
1482 S 1050 W
LAGRANGE, IN 46761
260-475-5340

PLEASE INCLUDE YOUR AD FORMAT OR A BUSINESS CARD WITH THIS FORM. IF YOU HAVE A SPECIFIC LOCATION IN THE BOOKLET YOU WOULD LIKE, WE WILL TRY TO ACCOMMODATE YOU IF POSSIBLE. AN ADDITIONAL SHEET WITH APPROPRIATE LOGOS, ETC. MAY ALSO BE SENT WITH THIS FORM.

TO BE INCLUDED IN THE BOOKLET, THIS MUST BE RECEIVED NO LATER THAN MARCH 15TH.

IF YOU WOULD LIKE TO BE ON THE WOLVERINE MAILING LIST AND RECEIVE THE MONTHLY NEWSLETTER CHECK HERE. ________________

DATE RECEIVED: ______________ CK#/CASH ____________ AMOUNT ____________