| Print out and complete this form |
| Local Computerized Services |
| Featuring the new
Internet Commercials called "Webmercials" (listing included) |
| Visit eCulpeper online (www.eCulpeper.com) |
| |
|
|
| eCulpeper.com Subscription Form |
| www.LocalComputerizedServices.com |
| Mail to: Local Computerized Services, P.O. Box 6708, Falls
Church, VA 22046 |
| |
|
|
|
|
|
|
|
|
|
|
|
| Already have a web presence? |
*Video Web Presences (VWP) are $499 |
Office Use |
| Annual Subscription Listing $199 |
All subscriptions are annual services |
|
| (link to eCulpeper.com) |
Listing |
Webcard |
Webmercial |
VWP* |
|
|
| Please include payment with application |
$199 |
$199 |
$399 |
$499 |
|
|
|
|
| Company Name & Address |
Your Name |
|
|
Your Current URL |
|
|
| Name: |
|
|
|
|
|
|
|
|
|
|
|
| Address: |
|
|
|
Your Title |
|
|
Your Email Address |
|
|
| |
|
|
|
|
|
|
|
|
|
|
|
| |
|
|
|
Your Phone # |
|
|
Requests |
|
|
|
| County: |
|
|
|
|
|
|
|
|
|
|
|
| Number
of Employees: |
|
Your Fax# |
|
|
|
|
|
|
| Annual
Sales: |
|
|
|
|
|
|
|
|
|
|
| Please circle below the One category that best describes your product/service: |
| Family |
Real Estate |
Education |
Careers |
Workplace |
Professional |
Online |
Commerce |
Travel |
Food |
Entertainment |
Health |
| Automobiles |
Consulting |
Financial |
Appliances |
Medical |
Government |
Pets |
Construction |
Apparel |
Manufacturer |
Gifts |
Other |
| Your
Contribution: Describe your Services/Products in detail
(and attach a brochure) |
|
|
| |
|
|
| |
|
|
|
|
|
|
|
|
|
|
|
| |
|
|
| |
|
|
|
|
|
|
|
|
|
|
|
| |
|
|
| |
|
|
|
|
|
|
|
|
|
|
|
| |
|
|
| |
|
|
|
|
|
|
|
|
|
|
|
| Please circle below all categories that best describe the nature of your business: |
| Local |
Regional |
National |
Worldwide |
Retail |
Wholesale |
Factory |
Engineering |
Hi Tech |
Services |
Products |
Diversified |
| Growing |
New |
Small |
Medium |
Large |
Home Based |
Subsidiary |
Franchise |
Corporate |
Partnership |
Sole Proprtr |
Other |
| Tell us your business story (the Founder,
special features, why should people patronize your business, how you got
started, etc.) |
| |
|
|
| |
|
|
|
|
|
|
|
|
|
|
|
| |
|
|
| |
|
|
|
|
|
|
|
|
|
|
|
| |
|
|
| |
|
|
|
|
|
|
|
|
|
|
|
| |
|
|
| |
|
|
|
|
|
|
|
|
|
|
|
| Please circle below all categories that best describe your primary customers: |
| One Time |
Repeat |
Seasonal |
Occasional |
Online |
Walk In |
Individuals |
Businesses |
Corporations |
Resellers |
Consumers |
Government |
| Men |
Women |
Ethnic |
Educational |
Home Owner |
Wealthy |
Young |
Mature |
Industrial |
Healthcare |
Professionals |
Other |
| Are
you interested in sponsoring on our site? |
|
|
For
a FREE 1 year subscription, would you refer 3 paying clients? |
|
| Would
you like more info on Webmercials? |
|
Does your organizatin
have similar offices in multiple cities? |
|
| Today's
Date |
|
|
Your Signature |
|
|
Office Use (agent #) |
|
| |
|
|
|
|
|
|
|
|
|
|
|
| By signing this application, I agree to the terms and
conditions listed on www.AllAmericanCommunities.com |
| *add
$35 for domain name if you want us to acquire one for you. |
|
| ©
Copyright Local Computerized
Services |
|
|
|
|
|
|
|
|
|
|
|
|
|