Global Dating Directory Advertising Order Form

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Please print the following form and return it via fax if using credit card payment or via postal mail if using payment by company check, or money order. Payable to: Micro Online Services, Inc.

Fax 1-858-481-2143

Micro Online Services, Inc.
PMB# 408,
3525 Del Mar Heights Road,
San Diego, CA 92130 USA
1-800-806-3210 ext 101, or 1-858-720-0203 ext 101

Advertising Purchase Order

Company Name :__________________________________________________

Contact Person :________________________________________________

Address:________________________________________________________

City:_________________________State/Prov:_______________________

Country:_________________________Zip Code:______________________

Email: ____________________________________________

Phone:_______________________Fax:_______________________________

Destination URL to send traffic ___________________________________

Url of graphic to be used ________________________________________

Note: All graphics are hosted on Micro Online Services servers. Banner graphic should be 468x60 pixels, under 15k bytes. Button graphic should be 90x60 pixels, under 7k bytes.

All prices are in US Dollars. Please check which program you wish to order.

__Global Clickthru Button Program 1,500 clickthrus $270 ________

__Global Clickthru Button Program 3,000 clickthrus $450 ________

__Global Clickthru Button Program 5,000 clickthrus $600 ________

__Global Clickthru Button Program 10,000 clickthrus $1000 ________

__Global Impression Rotating Banner Program 75,000 views $225 ________

__General category Exclusive top of page banner 20,000 views $120 ________
Url of requested page______________________________

__Home or MOB Exclusive top of page banner 40,000 views $400 ________
Url of requested page:_____________________________

__Add Deposit to Sponsor site PPC account ________
PPC account name ______________________________

Total Enclosed $________

Comments 

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Note: For availablity of exclusive banner positions at specified category, or home pages of Aarens.com, Applelove.com,
Alldatinglinks.com, or A1singles.com. Please contact info@microonlineservices.com to confirm availability before ordering.

Payment Method

___ Money Order (US$ payable on US Bank) ___ Personal Check (US$ drawn on US Bank) ___ Cash Currency US$ send via REGISTERED mail ONLY. ___ Visa ___ MasterCard

All payments should be in US $dollars. Checks or drafts should be issued by U.S. Banks made payable to Micro Online Services, Inc.. Company checks or bank drafts are preferred.

If paying via credit card, please complete the following and provide signature of card holder.

Credit Card Information

Credit Card Number:___________________________ Issue:_____ Expiry:_____

Your Name as printed on Card(PleasePrint):_____________________________

If billing address is different from address shown above, please write billing address here.

Address:________________________________________________________

City:_________________________State/Prov:_______________________

Country:_________________________Zip Code:______________________

I hereby authorise Micro Online Services, Inc. to charge my Credit Card, indicated above by the amount of $ ________US dollars.

Signature_________________________ Date _________________

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