:: Page Template 3 ::

submit your site / resubmitted By Us on the 20th of every month to provide optimal search engine exposure.

Please Complete Form

First Name:

Last Name:

Phone No:

E-mail Address:

Your Mailing Address:

Street # & Street:

City:

State/Province:

Name Of Website

.com .net .org

Domain Name Of Choice

PAYMENT METHOD: (CHECK YOUR METHOD OF PAYMENT.)

CREDIT CARD:

Card #:

Expiration Date: 0107 example

NAME OF CARDHOLDER: If same as above, type "SAME"

BILLING ADDRESS OF CARDHOLDER: If same as above, type "SAME"

Program	Monthly Cost	Check Plan
Search Engine Submittal Monthly	29.95 p/m

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