Blast Cleaning Directory - Add My Membership Listing to the Blast Cleaning Data Base!

Membership Listing Form
Name of Business: City: County: Country:	Street Address: 2nd line Street Address: State: Zip Code:
Do you want this street address in your listing? Yes No
Mailing Address: (If different from above)
3 digit North American Telephone Area Code: International Telephone Number E-Mail Address :(Required)	(7 digit North American) Phone No: Fax Number: Web Address:
Name of person authorized to make changes in this listing:
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?
What would you like to add to your listing?
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.)
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.
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.
Enter the amount you are paying:
Credit Card Type: Credit Card Number:	Name on Credit Card: Billing Address for Credit Card: Expiration Date:

By entering my credit card information I agree to the above payment amount. (You may cancel your subscription at anytime with written notice 30 days in advance of the next billing date.) \|

For any questions e-mail:

Or Telephone:

Ken and Ellen Ackerman at: +1 949 347-1500

Information About Dry Ice Blast Cleaning.

Market your blast cleaning services.

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Last Revised: 06/19/10

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