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BAITNET.COM STATE/PROVINCE AD BOX ORDER FORM

BAITNET.COM STATE/PROVINCE AD BOX ORDER FORM Please choose from one of the following three options for your ad box on our web site. Please circle only one option: 1) ad on one State page $15 per year

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BAITNET.COM STATE/PROVINCE AD BOX ORDER FORM

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  1. BAITNET.COM STATE/PROVINCE AD BOX ORDER FORM Please choose from one of the following three options for your ad box on our web site. Please circle only one option: 1) ad on one State page $15 per year 2) ads on three State pages $40 per year indicate selected states/provinces__________________________________ 3) ads on five State pages $60 per year If you want BaitNet.com to make an image for your ad box, put an “X” in this box If you would like to send us your own image, 90 pixels tall by 130 pixels wide, and less than 15kb, put an “X” in this box According to the option you have selected above, please send a check or money order in the proper amount, US funds only, to: Andy Bartels BaitNet.com P.O. Box 324 La Crosse, WI 54602-0324 Also, please fill out the form below to receive your free enhanced database listing. ** Please fill out the form below completely and accurately! ** We will send you an itemized receipt by mail that lists your service period dates. ********** Owner/Manager Name (your name will not appear on the website): _________________________________ Business name: __________________________________________________________________________ Address: _______________________________________________________________________________ City: ________________________________________ State: ___________ Zip: ____________ County: __________________________ Telephone (include area code): (_____)__________________________ Toll free number: (_____)_______________________ Fax number: (_____)_________________________ E-mail address: _____________________________________________________________________________________________ Internet address: ____________________________________________________________________________________________ Regular hours: ______________ Dates: ______________________________________________________________________ Special hours1: ______________ Dates: ______________________________________________________________________ Do you sell licenses (Y/N)? ____ Do you sell convenience items (Y/N)? _____ Miles to gas nearest station? _____ Nearby waters - names: ________________________________________________________________________________________ ___________________________________________________________________________________________________________ Primary fish species nearby: ____________________________________________________________________________________ Sell live bait (Y/N)? ____ Bait selection:__________________________________________________________________________ ___________________________________________________________________________________________________________ Sell tackle (Y/N)? ____ Tackle selection: _______________________________________________________________________ ___________________________________________________________________________________________________________

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