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| Your Name: |
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| Your Email (this is the same email we will send an invoice to): |
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| Your Website Address: |
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| The Headline of Your Ad: |
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| Ad Text (no longer than 200 words): |
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| Ad Link: (enter the web site address that your ad will link to) |
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| Image on your web site to use (optional - please enter the web site address where the
image is located) No larger than 125x125: |
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| Image should link to what web site address? (optional): |
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| Any Comments? |
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Note: Shortly, you will receive a confirmation email from us. You MUST click on the link
provided within the confirmation email. We will then send you your invoice. Your invoice must be
paid before we can place your ad.
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