Enrollment Form
(Less than 50 Character Ads)
Contact Information:
Name
Company
Address
City/State/Zip
Phone
Web Site
E-mail
Advertisement Headline, Description & URL Information:
Headline (up to 25 Characters)
Description (up to 50 Characters)
Display URL (maximum 35 characters)
Destination URL (maximum of 1024 characters)
Advertisement Duration, Agreement and Payment:
Start Date
mm/dd/yy
End Date
mm/dd/yy
Number of months
X Monthly fee of $100.00 = Total
ISCEA Standard Terms and Conditions:
I Agree
Mail a check
Pay Online (Visa, Master Card, Discover, Amex)