TCM Banner Ad Form

     * - required information

      Company Name: 
    Contact name *: 
           Email *: 

   Billing Address: 
       City/ST/Zip: 

Phone:(area code)*: 
   FAX:(area code): 

Check all account/s interested in:   Banner Ad Details

Create Banner Ads
 Rectangle 468x60 (flat/animated)     $200 setup
 Square 126x135 (flat/animated)       $200 setup


Host Banner Ads (setup fee waived if we create)
 Rectangle 468x60 (flat/animated)  $35/month $10/setup
 Square 126x135 (flat/animated)    $15/month $10/setup

Hosting fee includes on-demand web based
Hit and Click-Through Report for your banner ad.

      URL of existing banner: 
Click Through URL for banner: 

  Requested Start Date: 
     Expected End Date: 

Current Rotating Banner Cycles to choose from:
   (each cycle carries a separate hosting fee
    get one free cycle if you request 2 cycles or more)

    Cycle                Total Hits Hits/Day Clicks
   ----------              --------  ------  ------
  Business  (7)           3,281      18      39
  Webmail   (9)           5,254      16      80 
  Christian (12)          6,862      17     125
  Camping   (6)(special)  4,559      24      76

    Totals since June 4:    7,246     230     148 (2%)
     * note: above individual numbers represent
             overlapping banner ads, total is
             accurate for all banner cycles)

  Check Here if you want email notification of new cycles.

Monthly Billing available by Credit Card or Invoice in advance. 
    Quarterly Billing receives a 10% Discount 

Billing Option:  Credit Card    Invoice  
 Billing Cycle:  Monthly        Quarterly      Other

Card Name: NoneVisaMaster CardDiscoverAmerican Express 
Credit Card # (xxxx-xxxx-xxxx-xxxx):  
            Expiration Date (mm/yy): 

   Comments/Information/Questions: