Country Computer - Your On-Line Connection
Country Computer
Your On-Line Connection
www.country-computer.net
NETPAGE ORDER & RENEWAL FORM
(Please Type Or Print)

YOUR NAME:___________________________________________________________________________________

COMPANY:_____________________________________________________________________________________

ADDRESS:_____________________________________________________________________________________

CITY/STATE/ZIP:______________________________________________________________________________

POSITION/TITLE:______________________________________________________________________________

PHONE:______________________________________EXT:_____________ Fax:___________________________

WEB SITE____________________________________________________________Include on NetPage (y/n)?_____

EMAIL:______________________________________________________________Include on NetPage (y/n)?_____
Unless otherwise specified the phone number, fax number, emaill address & web site will appear on your NetPage.

* One Month NetPage $12.00...........$____________________
* Two Month NetPage $22.00..........$____________________
* Three Month NetPage $27.00........$____________________
* Three Month Menu Ad $60.00......$____________________
.............................................Total $____________________
*Be the first continuous NetPage in any area and your ad rate is locked in.
Specify Ad Category:_________________________
Sub-Category_________________________

Sign:_________________________________________________________Date:______________  
  • Netpages are posted upon reciept of this form with payement.  
  • Menu Ad orders and payments must be received by the 15th to be placed online the following month.  
  • All NetPages are created, and ownership retained by, Country Computer.  
  • Country Computer reserves the right to refuse ads due to content.  
  • Use back of form to describe your NetPage. For renewals enter NetPage number.  
  • By signing this form you agree to abide by the Service Agreement as posted at the Want Ads area of Country Computer.
    Send completed form and payments (check/money order) to:
    Country Computer
    442 Lake Ave
    Montello, Wi. 53949