Florida Association of Homes and Services for the Aging  

Job Mart Advertisement Application

 

 

 

DATE OF APPLICATION:                                              

COMPANY/FACILITY:                                                                                                                               

CONTACT PERSON:                                                                             TITLE:                                          

ADDRESS:                                                                                                                                              

CITY/STATE/ZIP CODE:                                                                                                                           

PHONE:                                                                        FAX                                                                    

E-MAIL ADDRESS:                                                                                                                                  

SPECIAL INSTRUCTIONS:                                                                                                                        

                                                                                                                                                                                                                                                                                                                                 

ADVERTISEMENT:                                                                                                                                   

(Please print or type 60 words or less)     

                                                                                                                                                               

                                                                                                                                                               

                                                                                                                                                               

                                                                                                                                                               

                                                                                                                                                               

                                                                                                                                                                

q	I am a FAHSA member – no charge!
q	I am not a FAHSA member – $25 for payment method, see below. Payment must be received prior to posting of ad.
q	I am requesting a BLIND AD.  Please include your name as the direct contact for my advertisement.

PAYMENT:

Credit Card:    q Visa    q MasterCard q American Express

 

Number:_____________________________________ Expiration Date: _______________

 

Name on Credit Card: _______________________________ 

 

Signature: _________________________________________

Check: Please mail to FAHSA at 1812 Riggins Road, Tallahassee, FL 32308, along with JobMart Application.

 

 

FAHSA USE ONLY
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