Online Business Directory

CONTACT INFORMATION

All fields except file upload are mandatory

First Name

Last Name

Email

Phone

____________________________________________________

ADVERTISEMENT REQUEST

Advertisement Level - - (complete all fields regardless of level)

Level A ($15 - 12-months)
Level B ($30 - 12-months)
Level C ($60 - 12-months)
Level D ($100 - 12-months)

Start Date

Business Name

Business Address - Street (or insert N/A)

City

State

Zip Code

Business Email

Website

Contact Person

Phone

Fax

Business Description (50 - 100 words based on level)

File Uploads - must fit within sizes listed (not mandatory). Max file size is 5mb.

Logo Upload (250 x 250px)

Icon Upload (80 x 80px)

Custom Page Art (540 x 700)

Additional Requests

My art is within guidelines, or no art is being submitted
I need my logo resized
I need my icon resized
I need my page-art resized
I am requesting a custom layout

__________________________________________

AD PLACEMENT

Art & Christian Gifts
Beauty
Computer Services & Repair
Electrical Services
Entrepreneurship
Home Improvements
Real Estate
Web Design
NEW CATEGORY PLEASE (see below)

Request New Category

Special Instructions / Change Request

Type Text Shown