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Advertising Order Form

Your name:
Your email address:
Website name:
URL of website:
Enter the url of your banner:
Or attach it to an email here.
Ad Type:
How many banner impressions? (Select if choosing impressions only)
How many click-thrus? (Select if choosing click-thrus only)
Enter your newsletter ad text.
50-100 words. SKIP if you are selecting banner advertising.
Credit Card Number:
(AXpress, Visa or Master Card.
Credit Card Expiration:

Enter the street address for your credit card statement.
ZIP-Code for your credit card statement.
Tell us anything else we need to
know. If you have more than one
banner, you can enter that here:




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