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Use this form for
signing up on any of the above web sites. You may print, complete
and fax it to us, or copy the details in an email and send it to us.
Our fax and email address are listed at the bottom of this page.
COMPANY INFORMATION:
Business Name:
______________________________________________________________________
Contact
Name:________________________________________________________________________
Address/P.O.
Box:_____________________________________________________________________
City/State/Zip:________________________________________________________________________
Phone:___________________________________________Fax:_______________________________
Email:___________________________________________
URL:_______________________________
Hours:
______________________________________________________________________________
Items for Sale
(this is
if you would like an online form for certain items)
____________________________________
Special Offers:
_______________________________________________________________________
Credit Cards
Accepted: ____ MasterCard ____Visa ____ American
Express ____ Discover
Please attach
the following on a separate page or send via email:
R
Company Logo
R
Photo of products or your business
Pages you would
like banners on:
________________________________________________________
COMPANY
DESCRIPTION
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
DIRECTIONS
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
Would you like to offer Gift Certificates Online through a
secure-server on
our sites?
Yes ____ No ____.
Any amount? ______ Forms will be faxed to
business or we can create an email account for you to receive the
orders.
Do we have
permission to take images and text off your website? ____ Yes
___ No
If you have
any questions please contact:
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