DetroitPages.Com
Order Form
Please print this order
form out, fill in the information below and send it with your payment to the
address below.
Name: _____________________________________________________
Address: ___________________________________________________
City:__________________________ St._____________Zip: _________
Telephone: _________________________________________________
Email Address: _____________________________________________
| Ad Listing |
Price Each |
Quantity |
Total Price |
| Basic Listing |
$39.95 Each |
. |
. |
| Gold Listing |
$59.95 Each |
. |
. |
| Platinum Listing |
$99.95 Each |
. |
. |
| Side Sponsor Link |
$9.95 Each |
. |
. |
| Top Button Ad |
$100 Each |
. |
. |
| Create Button |
$14.95 Each |
. |
. |
| Total Order |
|
|
. |
Terms: We accept Checks, Money Orders, and Credit
cards. If payment recieved is by check then we require 10 days for the check to
clear, Once we recieve your order, average time to submit your business is usually
1 week to 10 days. Use the back of the order form to send us your website and
coupon information. Also list which section to place your listing.
Make Check or Money Order payable to:
Richard Gory Jr.
2516
Emogene
Melvindale, Michigan, 48122
Enter your credit card information below, we accept Visa, Master Card,
Discover and American Express.
Name on Card:__________________________________________________________________
Card Type:_________ Credit Card Number:_________________________________
Exp. Date:___________CID#(if applicable-Required for
discover)__________
(Note:) Card type= V-Visa, MC-Mastercard, D-Discover,
AE-American Express
CID# is the 3 digit code on back of card (Last 3 digits
in white box).