Order Form

Document Sample
Order Form Powered By Docstoc
					                                              BAITNET.COM GLOBAL AD BOX ORDER FORM

Please choose from one of the following three options for your ad box on our web site. Please circle only one option:

1) 100,000 global views - $60

2) 200,000 global views - $100                we will notify you when your ad gets down to 5,000 views left

3) 500,000 global views - $200

If you want BaitNet.com to make an image for your ad box, put an “X” in this box

If you would like to send us your own image, 90 pixels tall by 130 pixels wide, and less than 15kb, put an “X” in this box

According to the option you have selected above, please send a check or money order in the proper amount, US funds only, to:
                                                                Andy Bartels
                                                                P.O. Box 324
                                                          La Crosse, WI 54602-0324

                             Also, please fill out the form below to receive your free enhanced database listing.
                                        ** Please fill out the form below completely and accurately! **

                                We will send you an itemized receipt by mail that lists your service period dates.

Owner/Manager Name (your name will not appear on the website): _________________________________

Business name: __________________________________________________________________________

Address: _______________________________________________________________________________

City: ________________________________________                 State: ___________                        Zip: ____________

County: __________________________                             Telephone (include area code): (_____)__________________________

Toll free number: (_____)_______________________                                    Fax number: (_____)_________________________

E-mail address: _____________________________________________________________________________________________

Internet address: ____________________________________________________________________________________________

Regular hours:      ______________         Dates: ______________________________________________________________________

Special hours1:     ______________         Dates: ______________________________________________________________________

Do you sell licenses (Y/N)? ____        Do you sell convenience items (Y/N)? _____         Miles to gas nearest station? _____

Nearby waters - names: ________________________________________________________________________________________


Primary fish species nearby: ____________________________________________________________________________________

Sell live bait (Y/N)? ____ Bait selection:__________________________________________________________________________


Sell tackle (Y/N)? ____   Tackle selection: _______________________________________________________________________


Description: Order Form document sample