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| INVENTORS' ONLINE RESOURCES DIRECTORY |
| Free Listing Invitation // Application Form // Inventors' Online Resource Directory |
Free Listing and Enhancements for VIPs
DATE:__________________
APPLICATION FORM
Introductory Offer
Please fill out this form and fax to 213 947-1079or mail in with your payment for any Listing Enhancements
| Name: | ___________________________________________________ |
| Company: | ___________________________________________________ |
| Address: | ___________________________________________________ |
| City/ST/ZIP: | ___________________________________________________ |
| Phone (H): | ___________________________________________________ |
| Phone (W): | ___________________________________________________ |
| Phone (other): | ___________________________________________________ |
| Fax: | ___________________________________________________ |
| E-Mail: | ___________________________________________________ |
| Web Site: | ___________________________________________________ |
CATEGORY:___________________________________________________
Listing Enhancement Options*:
| Item | Price | Total | Click Button to Pay Now with PayPal*** |
|---|---|---|---|
| Free Listing** | $00.00 | N/C | N/C |
| Email Link | $25.00 | $___________ | |
| Direct Link to Web Site and Email Link | $100.00 | $___________ | |
| 3-Page Brochure Web Site | $300.00 | $___________ | |
| 3-Page Brochure Web Site and Email Link and Direct Link to Web Site | $400.00 | $___________ | |
| TOTAL: | $___________ |
**Free Listing includes company name, address, phone number and fax number.
Form of Payment:
Amount Enclosed:$__________________Form of payment: __PayPal __Credit Card __Company check, cashier's check or money order
Credit Card:***PayPal: Major credit cards Visa, MasterCard, Discovery, American Express and E-Checks accepted through PAYPAL [owned by Ebay]. Please send PayPal payment to: sales@inventionconvention.com Note: PayPal is free to use to send payments, easy and fast to sign up, and secure. PayPal acts as an intermediary and your confidential credit card or bank account information is never revealed to vendors. Click here to sign up. Direct Credit Card Payments: __Credit Card [ ]Mastercard [ ]Visa | Number:_________________________________Expires:_______________ | Exact name as it appears on card:_____________________________________ | Signature:_______________________________________________________ |
Checks or Cashier's Checks, Money Orders
Make payment to: Invention ConnectionMail to: Invention Connection VIP Order & Processing Dept
P.O. Box 931881
Los Angeles, CA 90093-1881
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