Promotional Display Order Form

Please provide the following contact information:

Name
Title
Organization
Street Address
Address (cont.)
City
State
Zip Code
Phone
FAX
E-mail
Website URL

Please provide the following ordering information:

PROGRAM LENGTH	DISPLAY SIZE
Select Display Program Monthly Quarterly Program Six Month Program Annual Program	Select Display Size 180x60 Pixel Display 468x60 Pixel Display 480x64 Pixel Display
DISPLAY SOURCE
Provided in separate e-mail message: Send to (webmaster@westkentucky.com)  Provided on a disk being mailed ( West Kentucky Webworks, PO Box 45, Dexter, KY 42036) Please create new with this concept (MINIMUM: $25 charge, $60 if animated)  Pick up from my Website at: Please contact me to work out the details
ADDITIONAL COMMENTS:

PAYMENT IN ADVANCE IS REQUIRED

PAYMENT METHOD

CHECK BILL ME

CHARGES

DISPLAY SIZE MONTHLY QUARTERLY SIX MONTH ANNUAL 180x60 17.50 47.25 89.25 168.00 468x60 30.00 81.00 153.00 288.00 480x64 35.00 94.50 178.50 336.00 All monthly and extended programs must be paid in advance. 10% surcharge for billing. Payments accepted by Visa, MasterCard, Discover or Check. Discount of 20% each for 2nd or more repeating displays on different pages. We reserve the right to establish a limit to available promotional spots for all or any part of the West Kentucky Tourism Website. Our privacy policy is very simple: We will not share any of your information with any one.

My Total Payment Is:

MY CHECK IS BEING MAILED

Mail to: West Kentucky Webworks, P. O. Box 45, Dexter, KY 42036

PLEASE BILL ME AND MAIL AN INVOICE

We Will Bill You --  10% Surcharge