Print this form, fill it out and FAX to 360-733-6813 Sample Ad Page

Or mail this form to: Conditions Page

Northwestplaces.com LLC

1844 Lakeside Avenue, Bellingham, WA 98229-6018

Application for listing or recommendation

Business Name: __________________________________________________________________________

Mailing Address: _________________________________________________________________________

_________________________________________________________________________

Telephone: _____________________________Toll Free Phone: ___________________________________

FAX: _________________________________

e-mail: __________________________________________________________________________________

Web Site Address: http://www. ________________________________________________________________________________________

Contact Name: _______________________________________________Title: _________ Date: ________

Signature: _______________________________________________________

Recommendation and listing prices

ÿ A Recommendation with 50-word description in “Recommended by” section $150.00/yr.

ÿ Double wide recommendation with photo or graphic $250.00 / yr.

ÿ An enhanced listing $40.00/year. Yellow background, 25-word description, & link.

ÿ A listing only 20.00/ year. Name, address, and phone.

Save with 5-year contracts

ÿ A Recommendation $125.00 / yr. billed annually.

ÿ Double wide recommended listing with graphic $200.00/year billed annually.

ÿ Enhanced listing $ $35.00/year with link, billed annually.

Window Decals and logos for recommended or listed establishments

ÿ Send a free decal to display on my door or in my window: ___ 3” oval _____ 6” _____ 12”

ÿ Send a free CD with digital logos for use in my printing or on my web site.

ÿ Please update or add my listing. Fee $20.00 annually or per update.

Description: ______________________________________________

_________________________________________________________

___________________________________________ more space - use 2^nd page.