Seniorresource.com Website Listing Order Form

LISTING FORM

Yes, I would like my listing or banner added to Seniorresource.

Fill out the form below and hit the SUBMIT button or print and fax it to 866.252.6417. When we receive it, we'll contact you regarding placement choices and costs. Pricing is based upon the exposure your listing or banner is expected to receive based upon past performance. The more locations you appear, the less expensive it is per exposure.

Listings include two sentences that set you apart from your competition. Need help deciding what to include? We know our audience and the senior business and can help you work that out.

Name of contact person 
 
Company Name 
Mailing Address 
 
City 
State 
 
Zip

   Physical Address if PO is above

 City

 State and Country

Zip


 
										
					
 
								







Phone number 
 
Fax 
Email  
Web page URL 
Person filling out this form 
Date 
 
Listing placement page(s) 
Banner placement page (s) 

Message:

We reserve the right to refuse listings and banners deemed unrelated to the mission of seniorresource.com.

We'll use the information you send to structure a contract. If there are questions, (i.e. which page is best for your listing or banner to be placed, on how many pages should it be listed) we'll contact you first.

OOPS! I'd rather return to rate card information.

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