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Client Order Form - Advertising Form 11A Your Name _____________________________________________________ Company_______________________________________________________ Address ________________________________________________________ City _____________________________ State _____________ Zip _________ Day Phone (______)_____________ Fax # (____)__________________ e-mail address____________________________________________________________________ Instructions: Print or type you're advertising copy in 200 words or less. Be sure to show Bold, enlarged Font, or Capitals on the copy you present to us. Please include one of the following categories on the top of the form, Employment, Sports, Articles for Sale, Real Estate, Home Services, RV's Personals, Music, Marine, Travel, Business Services, or Other (and specify).When writing your ad, OPEN with a 5 to 10 word header for your listing that will grab your potential customer's attention. NOTE: There is a one-time processing and/or set-up fee for each Classified Ad. The processing fee is $3 each ad. Additionally, you may select the set-up you prefer in accordance with the schedule below. All processing, set-up, and quarterly ad fees are payable in advance and are non-refundable. Thereafter, you will be billed for the quarterly fees just prior to the end of your ad period, unless you notify us in writing prior to your renewal date. Please check all that you request:
Subtotal $________ + $3.00 Processing fee = TOTAL $________ METHOD OF PAYMENT: Please check one _______ Check ______Money Order (Payable to: GOLDEN WEB ENTERPRISES
Distributor Name _________________________ID# ________________ Ad Code _________
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