BAITNET.COM WEB PAGE ORDER FORM

In addition to the information you provide in the blanks below, please send up to four pictures (no polaroids, please), your business card, any brochures or other printed literature about your shop or the local area, so that we can us design a better web page for you. For photos, we recommend at least one inside and one outside picture, so viewers can get to know your shop ahead of time. Bait tanks, tackle racks, and view from the parking lot are some of the best shots to include.

You will also need to choose from one of the following six options for an ad box on our web site, so viewers can find your web page. Please circle one option:

1) ad on one State page $15 per year

2) ads on three State pages $40 per year indicate selected states/provinces________________________________

3) ads on five State pages $60 per year

4) global ad – 50,000 views $60

5) global ad – 100,000 views $100 (ads rotate through all pages)

6) global ad – 250,000 views $200

So, to figure your total cost, please add $60 (web page design fee) to the option you have selected above, and send along a check or money order in the proper amount, US funds only, to:

Andy BartelsBaitNet.comP.O. Box 324

La Crosse, WI 54602-0324

** Please fill out the form below completely and accurately! **We will send you an itemized receipt by mail that lists your service period dates.

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Owner/Manager Name (your name will not appear on the website): _________________________________

Business name: __________________________________________________________________________

Address: _______________________________________________________________________________

City: ________________________________________ State: ___________ Zip: ____________

County: __________________________ Telephone (include area code): (_____)__________________________

Toll free number: (_____)_______________________ Fax number: (_____)_________________________

E-mail address: ______________________________________________________________________________________

Internet address: _____________________________________________________________________________________

Regular hours: ______ Dates: ______________________________________________________________________

Special hours1: ______ Dates: ______________________________________________________________________

Do you sell licenses (Y/N)? ____ Do you sell convenience items (Y/N)? _____ Miles to gas nearest station? _____

Nearby waters - names: ____________________________________________________________________________________________

Primary fish species nearby: ________________________________________________________________________________________

Sell live bait (Y/N)? ____ Bait selection:______________________________________________________________________________

Sell tackle (Y/N)? ____ Tackle selection: _____________________________________________________________________________