Please print this form out, complete and mail to the following address.

CLASSIFIED AD FORM
Mail To:

Richfield Springs Mercury, PO Box 1349,
Richfield Springs, NY 13439 (315) 858-5858
Issue Dates To Run__________________________________________________
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19. 20. Over 20 words attach sheet
NAME___________________________________________________________
ADDRESS________________________________________________________
PHONE__________________________________________________________
NUMBER OF ISSUES TO RUN__________

PAYMENT:

CASH________________ CHECK________________#__________________