hookups

FRONT PAGE, 7th ROW
Rates $US: $79 monthly auto-renew, $89 for 1 month,
$199 for 3 months, $499 for 1 year

PURCHASE BY VISA OR MASTERCARD:

If you prefer to pay by a different method, please do not complete the form. Email us at

Ad Information

Stage name:

Web site url (f you have a site):

Tagline (3 - 4 words)

Text for ad (if you do not have a web site)

Row to be listed on:

Card Holder Information

Full Name

Address

Apt/Suite

City

Country

ZIP Code

Telephone

E-mail address

Credit Card Information

Amount:

Orders from Canada will have 5% GST added.

CC Type:

Card Number:

Exp. Date:

Card Verification Number
(3 digit code on back of card):

Please note: the fees charged are approximate and will vary slightly depending on your bank's exchange rate.

Credit card transactions will appear on your bill as "PRIME IMAGE CORPORATION".
Ads are NOT refundable.