orderform

ORDER FORM
RoadJunctionsUS
4420 North US 25W
Williamsburg KY 40769

BUSINESS NAME :______________________________
YOUR NAME:_____________________ TITLE: ______________
TYPE BUSINESS: ____________________________________
PHONE : ______________________ EMAIL: ________________________
BUSINESS DESCRIPTION / SPECIALTY/ PRODUCT: ______________________
___________________________________________________________________
STORE ADDRESS : ____________________________________________________
___________________________________________________________________

FOR YOUR NEW ADDRESS :    STATE ___________, INTERSTATE ________, EXIT # ______

FOR YOUR EXIT QUADRANT LOCATION:
          MARK ONE : (1)north west ___ (2) northeast____ (3) southeast ___ (4) southwest ___
          DISTANCE FROM THE EXIT: One mile or less ____   Over 1 mile (enter Miles) ____
             (This tells the traveler which side of the road you are on and distance to you.)
MY WEBSITE ADDRESS (url) is _http://www.________________________________________
Please contact me about building me a website _(optional)______________________________________

I wish to place a REGULAR FRONT PAGE AD $10/month payable Annually in advance.
    I am enclosing my check in the amount of $140.00 (Includes a one time set up fee of $20) _______

I wish to place a Premium FRONT PAGE AD   $30/month payable Quarterly in advance.
    I am enclosing my check in the amount of $110.00 (includes a one time set up fee of $20) ________

I wish to place a LOGO AD on the local page $24 annually.
    I am enclosing my check in the amount of $44.00 (Includes a one time setup fee of $20) _________

I wish to place my local portal link on the local front page $10 annually.
    I am enclosing my check in the amount of $30 ( includes a one time set up fee of $20) _________
    MY Web address is listed above

I understand that this is additional advertising on the web and should not be considered as a replacement of any other media ads I have placed, either on or off the web.
Signature____________________ Date___________________

Mail a completed copy of this form along with your remittance to RoadJunctionsUS at the above address.

Questions about your order call sales at 606-549-8962 or email sales@roadjunctions.us

Thank you for joining us on the front page. You will never be on page 10-B here. Within your advertising tier, you will maintain your placement number for as long as you desire.