RESERVATION FORM
Daniel Jara Statewide Hispanic Chamber of Commerce of New Jersey 150 Warren Street, Suite 110, Jersey City, NJ 07302 Tel. (201) 451-9512 Fax (201) 451-9547 E-mail: SHCCNJ@worldnet.att.net
CAMARA READY COPY
Payment Method:
Make Checks Payable to: Statewide Hispanic Chamber of Commerce
Check: Payment will follow:
Purchase Order: Purchase Order No.:
Credit Card: American Express Visa Master Card
Number: Expiration Date:
Contact Name:
Title:
Company Name:
Address:
City: State: Zip:
Phone: Fax:
E-Mail:
Deadline: September 16, 2005