• BUSINESS NAME:___________________________________________
• STREET ADDRESS:__________________________________________
• CITY:_______________________________ ST:____ ZIP:________
• PHONE:_______________________ FAX________________________
• CONTACT PERSON:__________________________________________

If you are connected to the internet, please supply the following info.

• WEBSITE URL:_____________________________________________
• E-MAIL ADDRESS:__________________________________________

If you are not connected to the internet, we will provide a small static webpage for $5 per month above your click rate. Please CLICK HERE for our reasonable click rates.

PARAGRAPH 1: Please suggest up to 100 words to be used under your listing.

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PARAGRAPH 2: Please send the URL of the image you would like us to use.

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If you would prefer to have us scan and enter a picture or logo, send it along.

PARAGRAPH 3: Use this paragraph for any comments.
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Mail to:

• Shrider Internet Advertizing
• PO Box 5047
• Norwell, MA 02061

Please read our disclaimer