Harvest Drive Online Ad Form Purchase Harvest Drive Advertising Ad SponsorThe information in this Ad Listing Details section will be published in the Harvest Drive E-Directory in early December. If you are purchasing a Family/Happy Ad, please complete the Family Name and Description/Message fields ONLY. Type of Ad(Required)Business AdFamily/Happy AdBusiness or Family NameDescription or Message:If placing a Business Ad, describe your company or services. If placing a Family/Happy Ad, list your message. The Description/Message is limited to 100 words or less.Description or MessageBusiness Address(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Phone(Required)FacebookTwitterInstagramWebsiteE-MailCategoryWhat category best describes your advertisement? Select “Family/Happy Ad” for non-business ads that express well wishes to PCHS or a student. Can’t find an existing category that suits your business? No problem, simply select *custom category at the end of the drop down list and enter your category.Choose Category:(Required)AccountingAutomotive (Sales)Automotive (Service)Banquet/CateringBeauty/SpaClothingComputersConcreteConstructionDentalFamily/Happy AdsFinancial ServicesFood/Grocery/LiquorFurnitureGas/PropaneGeneral ContractorHeating/CoolingHospitals/ProvidersHuman ServicesIndustrial / ManufacturingInsuranceMarketingMedical / DoctorsOphthalmology/VisionOrthodontistPetsPhysical TherapyPlumbingRecreation/SportsReligious/ChurchesRemodelingRental ServicesRestaurants/Carry OutRetail StoresSales AgencyScale and Measure EquipmentSolar PowerTile and Grout MaintenanceTransportationTravelVeterinary CareOtherCustom Category:If none of the above apply, what should the category be?Student CreditIs there a PCHS student(s) or family that should receive credit for selling this advertisement?Student/Family Credit:(Required)Yes, student name(s) listed belowNo, apply credit to a PCHS family with financial needNOTE: In cases of families with two or more students at PCHS, please list only one of the student's names. Credit will be divided equally among siblings.Student 1 First Last PCHS ID # (If known)Additional Student CreditYou may add up to three additional students or families. Credit will be divided proportionally.Student 2 First Last PCHS ID # (If known)Student 3 First Last PCHS ID # (If known)Student 4 First Last PCHS ID # (If known)Purchase OptionsPurchaser's Name(Required) First Last Address(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Purchaser's Email(Required) Purchaser's Phone(Required)Choose Purchase Option:(Required)Paypal/Credit CardCheck mailed to PCHSCheck hand-delivered to PCHSCheck given to student to turn in*Please note: You do NOT need a Paypal account to pay via credit card on Paypal.Please choose your ad level and then fill out the information below.Please Choose Ad Level:(Required)Platinum $500Gold $300Bronze – $100Test $1.00Platinum Level Ad Sponsor Quantity Price: $500.00 Quantity Gold Level Ad Sponsor Quantity Price: $300.00 Quantity Bronze Level Ad Sponsor Quantity Price: $100.00 Quantity Total IMPORTANT – PLEASE READ THE FOLLOWING INSTRUCTIONSIf you are paying by check, you only need to submit the form below and not complete the Paypal purchase portion after. Then: *Make check payable to PCHS *Write “Harvest Drive” in the memo section of the check *Include a printed confirmation of your online ad submission (you will receive via email) *Mail to: Providence Catholic Attn: Harvest Drive 1800 W Lincoln Hwy New Lenox, IL 60451 *Select “Yes” below once you have completed reading these instructionsDid you read the instructions?(Required) Yes Thank you!NOTE: Upon selecting the Submit Ad button below, you will be redirected to the safe and secure PayPal website. You DO NOT need a PayPal account to make this payment; you may pay with any major credit card.Payment MethodPayPal Checkout MasterCardVisaSupported Credit Cards: MasterCard, Visa Card Number Expiration Date Security Code Cardholder Name CAPTCHA Share this post
