Advertisement Order Form

Please complete the order form below.

A single block is 16x16 pixels and is available at a cost of £25 plus VAT per year.

Example Blocks:

You can purchase as many blocks as you like provided the space is available.

For example:

3 x 1 = 3 blocks = £75 plus VAT

4 x 2 = 8 blocks = £200 plus VAT

Advert Size:

x Estimate Cost £: plus VAT

Title:

	First Name:		Last Name:

Company Name:

Address 1:

	Address 2:

Address 3:

	City/Town:

Postcode:

	Region/County:

Country:

Email:

	Telephone

Fax:

Web Site:

No http://

Category:

Other Category;

Site Title:

Alt Tag:

Pop Up Text:
(Maximum characters: 50)

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Description:
(Maximum characters: 250)

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Logo/Image:

Note: file must be .jpg