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
Top Banner Game Home Page
$100 Per Year
1
.
Top Banner Menu Page
$50 per year
.
.
Lifetime game sponsor
$24.95 Each
.
.
Non Reciprical Link
$10 per year
.
.
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).