Advertising Order Form *This information will appear in the ad. Return to Home Page
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Make Check Payable to: Tribute Marketing
Mail to: Tribute Mktg. Box 802, Attleboro, MA 02703
Payment by Credit Card? Fax form to 508-455-4647 |
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*Company |
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Contact Name |
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| *Address, City, State, Zip | |||||||||||||||||
| *Telephone | |||||||||||||||||
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AUTHORIZED SIGNATURE (Required for Credit Card Payments) |
x | ||||||||||||||||
| *Truck and/or tank capacities | |||||||||||||||||
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*Types of Water Service (Industrial wastewater tankers not permitted. Potable, pool, only.) |
__ Potable __ Swimming Pool __ Sea __ Tank Rentals __ Emergency/Disaster Relief __ Landscaping or Compaction |
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| *Geographic Service Areas: | |||||||||||||||||
| Additional information | Your potable water state license #_________________ | ||||||||||||||||
| *Your Web Site Address (if any): | |||||||||||||||||
| If you do not have a web site ... |
Would you like to receive a quote? __Yes __No |
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Advertising Service Requested
Total Payment: $ _______ Per Month -Subscriber $ _______ Per Year - Subscriber |
__ Text Listing $10 Monthly or __ $120/Yr. TopLocked under banner __ Banner Ad $15 Monthly or __ $180/Yr. TopLocked, as avail. __ Banner Ad $180/Year (see web site for terms) __ I will need a Free Banner Ad/Image Designed __ I will email artwork to: info @bulkwaterdelivery.com __ 1 Yr. Top-Position Locked-In for my state (if available) |
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| Method of Payment | ___ Check/Money Order ___ Credit Card | ||||||||||||||||
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Select Card Type: ___MC __VISA |
Expires ___________ 3-digit Sec. Code __ __ __ |
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| Billing Address for Credit Card if different from above address | |||||||||||||||||
| Desired Date to Begin Running Ad? | From __________________ to _________________ |
