(Form to accompany Payment)
I would like you to provide a "Closer Look" hyperlink to my home page(s):
Subscriber name: _________________________________________
Subscriber Title: __________________________________________
Address: _______________________________________________
City: ________________________________
State: _______________________________
Province: ____________________________
Postal Code: _________________________
Phone Number: ( ) _____________________
Fax Number: ( ) ______________________
E-mail address: ______________________________
Number of URL hyperlinks desired: ___________ (at $49 per URL per year )
URL #1: http://___________________________ URL #2: http://______________________________
URL #3: http://___________________________ URL #4: http//______________________________
Enclosed, please find a __ check __money order in the amount of $ _________________
Signed: ______________________________________________
Print Name: __________________________________________
Date: ______________________
Return to:
| Closer Look |