| CLASSIFIED AD ORDER INFORMATION: (Please PRINT &
fill out applicable fields
completely) |
| Name: |
____________________________________________ |
| Company: |
________________________________________________ |
| Business: |
_____________________________ (type) |
| Address: |
________________________________________ suite # _________ |
| City: |
_______________________________________ |
| State, Zip: |
_________ (zip) _______________________ |
| Phones: |
Day:_________________ Eve: _______________ FAX: ____________________
|
| E-mail Address: |
________________________________ |
| Web address to be linked: |
_______________________________________ (leave blank if not
applicable) |
| Classified Ad Description: Limit words to Ad type as chosen above
(Commission Ads attach text). Lines 1-5 is what will be posted for public display, all
other information is for office use only. Be sure to list your price
and contact info in the lines below. |
| Section to be Listed in: |
_______________________________ We will assign section if left blank. |
| Line 1: |
_________________________________________________________________ |
| Line 2: |
_________________________________________________________________ |
| Line 3: |
_________________________________________________________________ |
| Line 4: |
_________________________________________________________________ |
| Line 5: |
_________________________________________________________________ |
| Contact Name: |
_________________________________________________________________ |
| Payment Options: |
[ ]Check, [ ]Money Order, [ ]Credit Card
If Credit card, please list type:_________________ (We accept: Visa, MC,
AMEX) |
| Card Info: |
Name on credit card:____________________________________ |
| Number & date: |
Credit card #:_________________________ Expiration Date (Mo/Yr):_____________ |
| Please give us comments or special request for Ads. |
| ______________________________________________________________________ ______________________________________________________________________
______________________________________________________________________ |
| Questions or suggestions ? Please ask them! |
| Service improvements:__________________________________________________ __________________________________________________________________We
aim to please !!! |