| Name:
__________________________________________
Address:
_____________________________________________
City:
________________________________________________
State:
_______________________________________________
Country:
__________________ Zip/Postal Code: _____________
Email Address: _________________________
Phone
Number: _________________________
Fax
Number: ___________________________
Credit Card Type: ___ VISA ___ MasterCard
Card
Number: _________________________________________
Expiration
Date: ________
Name
as Printed on Card: ________________________________
Signature:
__________________________________________
On
What Date (begin Monday) Would You Like Your Ad to Start?
________
How
many weeks would you like your ad to run? ______________
Cost: $80 for three months or $100 per six months
Please
select:
Three Months: ___ for $80.00
Six
Months: ___ for $100.00
Select
A Category For Your Ad:
___ For
Sale ___ Real Estate ___ Wanted To Buy ____Rentals
___ Services ___ Personals ___ Employment
____Miscellaneous
___ Animals/Pets
If you
wish to include an image with your ad please include a floppy
disc with a GIF or JPEG image on it. Or send a non-returnable
camera-ready hard copy image to:
Baja
Life Online
P.O. Box 4917
Laguna Beach, CA 92652
Phone: (949) 376-2252
Fax: (949) 376-7575
I wish
to send my image via email attachment: ____
I have enclosed an image with my order: ____ Floppy Disk ____
Hard Copy
I do not wish to place an image in my ad: ____
Please
Print The Text As You Wish It To Appear In Your Ad:
(98 words maximum, including your name, address, phone
or email.)
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
Remember:
Type the text of your ad exactly as you wish it to appear.
Include your email address, phone number or address in your
ad.
If you
need further information contact us at sales@bajalife.com
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