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
                                                                BaitNet.com
                                                                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: _______________________________________________________________________


___________________________________________________________________________________________________________

				
DOCUMENT INFO
Description: Order Form document sample