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Membership Listing Form |
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Street Address: |
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Do you want this street address in your listing? Yes No |
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Mailing Address: |
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3 digit North American Telephone Area Code:
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(7 digit North American) Phone No: Fax Number: Web Address: |
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Name of person authorized to make changes in this listing: |
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| Do you sell dry ice blasting equipment? | Do you lease or rent blasting equipment? |
| Do you produce dry ice? | Do you distribute dry ice? |
| Do you offer dry ice to the public? | |
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What would you like to add to your listing? |
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| Information for extra line: (Such as area service is offered, or company "motto"): | |
| Cost for basic membership: Monthly (minimum) $ 19.95 Annually $ 99.00 per Year. | |
| Cost for logo membership: Monthly $ 19.95 Annually $ 199.00 per Year. (Please email your logo if I can't copy it easily from your website.) | |
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Please add a logo ad with membership
at the side of the listing page for a total of : Monthly $29.95 Annually $ 298.00 per Year. |
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Please add a logo ad with membership
at the top of the listing page for a total of: Monthly $49.95 $ 495.00 per Year. |
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Enter the amount you are paying: |
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Credit Card Type:
Credit
Card Number: |
Name
on Credit Card: Billing Address for Credit Card: Expiration Date: |
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By entering my credit card information I agree to the above
payment amount. | |
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