BASIC LISTING     $19.95 plus tax
    (Business Name, Telephone Number & Address)  Example . . .

Acme Antiques     724-999-9000
    123 Main Street, Sharpsville, PA 16150

Business Name
Address
City    State   Zip
Telephone # 

ADDITIONAL INFORMATION  (Required)

Owner/Manager Name 
Title 
County   E-mail

PAYMENT INFORMATION

Price = $19.95 ($21.15 Total) For the Whole Year - NOT MONTHLY

   Credit Card   Select One VISA MASTERCHARGE AMERICAN EXPRESS DISCOVER
   Card Number
                                16 digits (except Amex 15 digits)

Name on Card
Card Billing Address
City    State   Zip
Card Number   Example: 1234-5678-9012-3456
Expiration Date    Example: March 2003 = 0303