911Search Order Form

To place an order by Postal Mail or Fax

Please complete and print the order form below and mail or fax your order.

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"OVER 20,000 BUSINESSES come on the Internet EVERY single day...
If you don't advertise... YOUR COMPETITION WILL!"


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[ 911Search.com ]: Easy Ordering Instructions
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=> Once your order is received we will IMMEDIATELY CREDIT your
account and place any banner ads up for display.
=> Banner advertisers will be notified by email how to access their stats online.


** YOU CAN ORDER NOW! ALL Major Credit Cards are Accepted and will be billed by Compuworx Corporation! Most Fax orders using Credit Cards can be processed within 24 hours. For postal orders U.S. and Canada allow up to 7 days. EUROPEAN & FOREIGN Residents allow up to 14 days.

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[ TO ORDER BY FAX ]:
To order advertising by fax with a Credit Card, please print out the order form at the bottom of this email and complete all necessary blanks. Then, fax the completed order form to our Order Department in the USA at: => (973) 761-6901

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[ TO ORDER BY POSTAL MAIL ]:
To order 911Search Pay-Per-Clicks or Banner Advertising with a Cashiers
Check, Credit Card, US Money Order, US Personal Check, US Company Check, or US Bank Draft by postal mail, please print out the order form at the bottom of this email and complete all necessary blanks. NOTE: Personal and Company Checks will delay orders.

Send all orders with payment in US dollars to:

Compuworx Corporation
104 Van Ness Ct. Bldg. #3
Maplewood, NJ 07040
USA


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[ 911Search.com ]: ORDER FORM
(c)1999 -2007 Compuworx Corporation. All Rights Reserved
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You can check one or more selections below when ordering:

468 x 60 and 468 x 50 Banner Ad Specials (same price).
100,000 viewed impressions $400 You Save $1600 . [ ]

250,000 viewed impressions $1000 You Save $4000 . [ ]

20,000 click thru $400 You Save $1600 . [ ]

50,000 click thru $1000 You Save $4000 . [ ]

468 x 60 and 468 x 50 Banner Ads (same price).
Views: Amount: Purchase: Clicks: Amount: Purchase:
1250 $25.00 [ ] 1250 $125.00 [ ]
2500 $50.00 [ ] 2500 $250.00 [ ]
5000 $90.00 [ ] 5000 $450.00 [ ]
7500 $120.00 [ ] 7500 $600.00 [ ]

120 x 60 and 120 x 120 Spotlight and Featured Banner Ads
Views: Months: Amount: Purchase:
Unlimited 120x60 1 month $125.00 [ ]
Unlimited 120x60 3 month $300.00 [ ]
Unlimited 120x120 1 month $275.00 [ ]
Unlimited 120x120 3 month $750.00 [ ]

URL where banner is located: ________________________
Example: ( http://mysite.com/images/mybanner.gif ) Your banner will be downloaded from the location specified above.

Pay Per Click orders: Enter USD amount $_______________

***Total amount of order: Enter USD amount $____________

Company Name: ______________________________________________

*Your Name: _________________________________________________

*BILLING ADDRESS: __________________________________________

*City: ___________________ *State/Province: ______________________

*Zip/Postal Code: __________ *Country: __________________________

*Phone Number: ______________ Fax Number: ____________________

*Email Address: ______________________________________________

** To Purchase by Credit Card, Please Complete the Following:

Visa [ ] Mastercard [ ] AmEx [ ] Discover [ ]

Name on Credit Card: _________________________________________

Credit Card Number: _____________________ Exp. Date: ___________

***Amount to Charge Credit Card (enter total dollar amount): __________

CC Holder Signature: __________________________________________
(Must match billing address above.)

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* Required information for all orders.
** Required for Credit Card orders.
*** All dollar amounts will be credited to Shared Profit, in $25 increments.