Registration  Form  

       

       CHRISTIAN BUSINESS EXPO, 06  

          Call 888-797-6484 or email to: business@cbepage.com

Contact Person:

Company Name:

City:

State:

Zip:

Phone and Fax Number:

Email:

Diamond Package:

Gold Package:

Silver Package:

Advertising On::

Form of Payment:

Credit Card Number:

Credit Card Verification# ( 3 digits on the back of the credit card):

Type of Credit Card:

Name as it appears on Credit Card:

Expiration Date:

Amount of Payment:

Billing Addres:

Comments:

ALL DEPOSITS AND PAYMENTS ARE NON-REFUNDABLE

Company Name:_________________________________

Phone:______________ Fax:_______________________

Contact Person:__________________________________

Address:________________________________________

City, State, Zip Code:______________________________

Email:__________________________________________

PLEASE CHECK ALL ITEMS YOU ARE PURCHASING

Exhibitor Package: Gold $300(__), Small Business $250 (__),

New Business & Non-Profit $150 (__) Advertiser Package $80 (__)

Multiple Booth Discount: 20% Off  (__)

Electricity for Booth: $100 (__)

TITLE SPONSOR: $1,500 (__)

EVENT SPONSOR: $1,000 (__)

Total Amount Owed:$____________

Payment Type: Check(__)   Money Order(__)    Credit Card(__)

Please Make Checks Payable to:  

          Christian Business Expo

          Attn: Jairo Sequeira

          574 Chaparro Road

          Covina, CA 91724

To Pay by Credit Card Please Complete and Sign the Following:

Type of Credit Card (Visa or Mastercard):______________________

Print Name as it appears on Card:____________________________

Credit Card #:_____________________________________________

3 Digit Verification # (as it appears on back of card):_____________

Expiration Date#:__________________________________________

Billing Address:___________________________________________

_________________________________________________________

Phone Number:___________________________________________

Signature of Card Holder:X__________________________________

ALL DEPOSITS ARE NON-REFUNDABLE