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Advertise
on
Island Pond Dot Com
Online Order Form

Please fill in this form and submit it.
You will not be billed until your ad is placed on our web site.

Name - First / Last *
Mailing Address *
City / Town *
State / Zip Code *
Email Address *
Contact Telephone Number *
I would like to Advertise on Island Pond Dot Com *
I would like to place an ad on your Amenities section ($10.00 per year) *
I would like to place a banner ad on your web site Plus an ad in your Amenities section ($25.00 per year) *
I would like to place a banner ad on your web site Plus an ad in your Amenities section and make us a one page sub-web site. ($50.00 per year) *
Description of your ad (200 words or less) *
Web Site URL (www.yoursite.com) *
Email Address (to be used in ad) *
Phone Number (contact number to be used in ad) *
Street Address (location of business for ad) *
State / Zip Code (for use in ad) *
Contact Name (for use in ad, IE: Mary / Joe Doe) *
Fax Number (to be used in ad) *