Fastrak Advertising Application

National Handi-Men.com Directory Advertising All sections must be completed
Do you wish to place advertising in all of the Directories? Or only in the a specific Directory?
Your Full Name
Your Company Name
Location of Advertising	- http:// Do not use http as part of the location name!
Name of ad or graphic:	*Don't forget the gif or jpg extension!
Your Email Address
Phone (include Area Code):
City / State
Do you wish Click Through? :	Yes, No (Click throughs are charged at $3.50 each!)
If you wish a click through please provide the location	- http:// Do not use http as part of the location name!