MediaDirect2000 - Overview



	MediaDirect2000 *"Bringing Changes & Results to Web Base Marketing"*

Application

Create Username:
Create Password:
Re-type Password:

Last Name:
First Name:
Middle Initial:
Company Name:
E-mail Address:
Telephone Number(s):
Address:
City:
State/Province:
ZIP Code:
Country:

Type of Credit Card:

Credit Card Number:

Date of Expiration: /

Do you require a Web site? Yes No

I authorize MediaDirect2000 to deduct a one-time fee of $199.95 in order to join the elite network of merchants advertising in malls for Professionals, Cosmopolitans, Singles, and Teens. I understand I have the right to cancel this agreement at anytime. I also understand I will be charged $59.95 a month for each of the virtual malls I choose to advertise in, and that I am entitled advertisement space for up to five items at that price; I can pay $59.95 for each additional group of five or fewer products. Finally, I understand that if I join by October 1, 2000, I will receive the first month on any or all malls FREE:
Yes No