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Please fill out the form below to submit your advertisement order online. You can attach any artwork or text as well. If you would like your advertisement developed by the HMD art department please indicate so in the comments area.

Note - Previous advertisers have first right of refusal on premium positions. Please let our office know to notify you should a premium position become available

** Denotes Required Field.

Company/Doctor's Name: **
Contact Name: **
Phone #1: **
Phone #2:
Fax:
E-mail: **
Address #1: **
Address #2:
City: **
State: **   Zip Code: **
Comments:

AD SELECTION

Directory Selection: Citrus
Hernando
Ocala
Tri-County


Choose a Listing, In-Column or Display Advertisement selection. You need only select ONE selection from one of the three sections.
Listing:
Listing Color Selection:

In-Column:
Column Color Selection #1:
Column Color Selection #2:

Display:
Premimum Position Availability Alert: N Y


Attach File:


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