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BUSINESS LISTING INFORMATION
(Complimentary with Display Advertising and Industry Report Subscribers)

Please DO NOT hit your RETURN key before completing:

NAME OF BUSINESS:

Company/Corporate Name:

Area To Be Listed Under:

Other Area, Not listed above:

Street #/ Street Name / P.O. Box #/ Apt #/ Suite and Phone #, Area Code First:

If multiple locations, please fill in below

City:

State/Province:

Zip Code or Postal Code:

Email Address:

Web Site Address:

Specialty Services:

 Hours of Operation:


Additional Comments On Your Establishment:

Number of years in business and any background information you feel is important:

Describe any offers you currently have:

Credit Cards You Accept: Select All That Apply

American Express

Visa

Carte Blanche

Diners Club

MasterCard

Discover

Other, Please List

PLEASE LIST MULTIPLE LOCATIONS BELOW:

Street #/ Street Name / P.O. Box #/ Apt #/ Suite and Phone #, Area Code First:

City:State/Province:

Street #/ Street Name / P.O. Box #/ Apt #/ Suite and Phone #, Area Code First:

City:State/Province:

Street #/ Street Name / P.O. Box #/ Apt #/ Suite and Phone #, Area Code First:

City:State/Province:

Street #/ Street Name / P.O. Box #/ Apt #/ Suite and Phone #, Area Code First:

City:State/Province:

Street #/ Street Name / P.O. Box #/ Apt #/ Suite and Phone #, Area Code First:

City:State/Province: