Application for Ad
Placement & Insertion Order
We
would like to advertise on one of your websites, and are submitting our
completed
application
with signature of our company’s officers along with the correct payment for
your
review
and acceptance.
The website that we would like to
advertise at is located at: (fill in the internet
address or
domain name below)
www.__________________________
We have completed all of the following information
found on the application and insured that we have checked the following items
before returning application and initial payment for your service:
* selected the website or websites that you want to advertise on
*
selected “Advertising Option(s) #1, #2, or #3”
* returned the ad in the wording and
* Ad may be in a foreign language but must be typed using English
type/characters
*
signed and dated the application - application must be signed by officer of the
company
*
initialed your Acceptance of our Terms & Conditions
* enclosed the correct payment which includes 2 monthly payments consisting of
the first
month and last month.
We
select the following advertising option(s):
_______
Advertising Option # 1: Frontpage/Homepage
We select the Top Banner Ad at
$__________ / month
We select the Bottom Banner Ad at
$__________ / month
NOTE:
Maximum Banner Ad Size is 728 x 90 pixels
Unless
otherwise requested, we will include a link to your website in your Top/Bottom
Banner Ad.
Please
email us your banner ad that conforms with the above size requirements.
Alternatively, we
can
design your banner for an additional fee of $995.00 wherein we will offer three
customized
banners
for your selection. Additional
designs are $250.00/each with a limit of 6 banners that we will
propose
for a total of 9.
_______
Advertising Option # 2: One
Page Ad Inside
NOTE:
Maximum Number of Words is 250 – Additional words available at $_______
/ word.
The average word
contains an average of no more than 8 letters.
Our
250 page ad reads as follows
_______
Advertising Option # 3: E-mail
Address (where available)
We would like the email
address of: _________________@______________
At the price of $199.95 /
month
Applicant’s
contact information:
Your
name:
______________________________________
Title:
______________________________________
Company
name: ______________________________________
Company
address: ______________________________________
City: _______________ State _______________
Zip
or country code _______________
Country
_______________
Telephone
_______________ (include
country code if outside of the U.S.A.)
Fax
#
_______________
Website
______________________________________
Email
address
______________________________________
List your primary banking
reference:
Bank
name
______________________________________
Bank’s
address
______________________________________
Bank’s telephone number
_______________ (include
country code if outside of the U.S.A.)
Bank
officer’s name ______________________________________
Website
address of bank: ______________________________
Last
4 numbers of your company’s primary account number:
_______________
To
help us better understand your company, please list all of your company’s
primary Products and Services:
1. ____________________
6. ____________________
2. ____________________
7. ____________________
3. ____________________
8. ____________________
4. ____________________
9. ____________________
5. ____________________
10. ____________________
How can we improve our website? (please
attach your recommendations)
Terms & Conditions:
1. All prospective advertisers must complete application and receive owner’s approval before acceptance of customer's advertising insertion order.
2.
Domain
name owner reserves the right to
accept or reject any application.
3.
All prospective advertisers must agree to minimum
of one year advertising term.
4.
First and last month's fee for advertising are
required at time of application. Applications without payment will be rejected.
5.
Payments must be received in our office no later
than the 5th of every month. Advertisers that have not made payments by the 5th
of the month will have their ads removed on the 6th.
6.
All prospective advertisers applications must be
approved before new ad insertion.
7.
Applications that are not approved by Company may
be accepted on a conditional basis for an additional pre-payment (not a
deposit).
8.
Additional deposit(s), if required, will be
returned to customer within 3 business days after 12 month term is completed,
and customer is not in arrears. Any arrearages will be deducted from
deposit before returning.
9.
Maximum ad size for Top and Bottom Banner ads is:
728 x 90 pixels.
10.
Maximum number of words in Option #2 (one page ad
inside website) is 250.
Additional words available at $________ / word.
11.
No
refunds - no exceptions.
______________________________________
Company Officer’s Signature
______________________________________
Company Officer’s Title
______________________________________
Date
Your
signature here indicating that you certify all of the information in the
Application above is true and correct and that you have read, understood and
accept all (11) of the Terms and Conditions above.