Site Submission Order Form

Please fill out the form completely so your order can be processed. After payment is processed and your site submission completed, you will receive a complete site submission report via email.

Name
Email
Company Name
Street Address
City/Town
State/Province
Zip/Postal Code
Country
Phone
Fax
Site Title:
Your URL:
Keywords (3 words or phrases, separated with commas):
Describe what you're offering on your web site in 15 - 20 words:
How did you find this site?:	Banner Advertisement Print Publication Search Engine Link on another site Someone told me about it Other
Method of Payment	Visa or Mastercard VISA MASTERCARD Name on Credit Card Credit card number Expiration Date / Your credit card will be charged $25.00 and the vendor shown on your statement will be MTC. Check or Money Order
Please make check or money order payable to:	Internet Magic 112 Mountain View Ave. Santa Rosa, CA 95407

   

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