ORDER FORM

£150.00 + Vat at 17.5% per month per Keyword Phrase

Minimum contract 12 Months, Terms & Conditions apply.

1st URL (Website address to be promoted)

1st Keyword Phrase

Short description (8 to 16 words)

2nd URL (If different from the 1st URL)

2nd Keyword Phrase

Short description (8 to 16 words) if different from 1st URL

3rd URL (If different from the 1st URL)

3rd Keyword Phrase

Short description (8 to 16 words) if different from 1st URL

FREE 4th URL

FREE 4th Keyword Phrase

Short description (8 to 16 words) if different from 1st URL

In order that we may optimise your website and/or create mirror pages to be promoted we require the website username and password.

To Follow      Unknown

Username                                   Password 

Your Name

Phone Number

Email Address

Organisation Name

Address

Post Code

Billing Details

Invoice Monthly Invoice 12 Months in Advance - 5% Discount Credit/Debit Card Monthly Credit/Debit Card 12 Months in Advance - 5% Discount Standing Order Monthly

Credit/Debit Card Details (Visa/Mastercard/JCB/Switch/Delta only)

Exact name on card

Card Number             Expiry (MMYYYY)      Issue Number (Some cards only)

Card billing address if different from above.

Notes/PO Number.