MEC Business Member Company Name(Required) Contact Person(Required) First Last Phone(Required)Email(Required) Do you have a website address?(Required) Yes No Website Address(Required) Physical Address(Required) Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Billing Address(Required) Same as Physical Address Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Brief Description of the Company(Required)Company Logo(Required) I am attaching my Company logo jpeg here I do not have a jpeg Company logo Attach your Company logo jpeg here(Required)Max. file size: 100 MB.Advertising Options Cutoff date for our January 2024 Currents magazine will be Friday, October 27, 2023.I’d like to sign up for the following paid advertising:(Required)Choose all that apply 1/4 page color ad - $200 1/2 page horizontal color ad - $400 1/2 page vertical color ad - $400 1 page color ad - $700 Inside front cover color ad - $1,000 Inside back cover color ad - $1,000 Annual advertising package, of the same size ad, and receive, one of four ads, free I’m already a Co-op Connections Member and would like to advertise using my free Co-op Connections Member 1/4 page color ad. I’d like to become a Co-op Connections Member and begin utilizing my free Co-Op Connections Member 1/4 page color ad. Promotion/AdvertisementWhat’s your current Co-op Connections promotion?(Required)I’ve attached my paid promotion/advertisement jpeg here(Required) I’ve attached my paid promotion/advertisement jpeg here Upload paid promotion/advertisement hereMax. file size: 100 MB.I need help designing my free Co-op Connections promotion/advertisement. I need help designing my free Co-op Connections promotion/advertisement. I need help designing my paid promotion/advertisement I need help designing my paid promotion/advertisement Consent(Required) By signing below, I agree to the advertising policy of Mohave Electric Cooperative, Inc. Currents magazine. Any and all, advertising costs are due upon acceptance of this advertising application.Business Name(Required) Authorized Electronic Signature(Required) EmailThis field is for validation purposes and should be left unchanged.