The Electronic Referral Network
Advertising Request
Full Name:
Phone / ID:
11 Digits Only - Do not include spaces, dashes or hyphens
Enter your phone number with area code plus 0.
E-mail Address:
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I may not be able to send anything to you.
Earthlink and Mindspring's policy is to delay and block e-mail.
Please get a hotmail.com e-mail for this program if you do not have a regular POP3.
Enter the correct fields for your selected AD.
Coded / Update CD:
Check if you are requesting a Coded CD ($50) sent to you on this order.
Your Signature Name:
This is sent in Email
Your Display Name:
This shows on CD AD
Web Business Name:
(27 Characters max Recommended Directory)
Website Address:
If no website we direct to other websites.
Redirect Website:
Check to protect the website so you can change it in the future. $360/year.
E-Mail Address:
Text Pager Address:
Category1
Select short highly searchable terms.
Category2
Category3
City
If a small town pick a larger close city to search you.
Phone
Reference Number
This is the number you created with your order.
Indicate the type of AD you purchased:
National Directory
E-Book
Distribution AD
National Member
Local Directory
Local Member
Other
Include any additional information in the notes below:
Paper Form
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284 visitors since 9/24/2009.
Please note that we charge $10 extra if data submitted by paper form.