Answer only the questions that apply. We will use the information to design an Ad for your business. We will then e-mail or Fax the design back to you for approval or changes.

*Name:

Business Name:

*Email:

Phone:

Fax:

Address:

List 3 to 6 products that you sell or services that you provide:

1.

2.

3.

4.

5.

6.

List anything about your services or products that make them unique or different from your competition.

Unique Services/Products:

Is there something that you may want to offer in the Ad that would motivate the potential customer to call or visit your place of business (e.g., free estimate or free consultation)?

Special Offer(s):

Is there a license, certification, or special training/education associated with your business? If so, please list.

License/Certification:

List other information that, space permitting, could be included (e.g., Yrs. in business, Yrs. of experience, mottos, or guarantees).

Other Information: