Order Form
Targeted impressions 5,000 ($100) 10,000 ($200) 25,000 ($400) 50,000 ($700) 100,000 ($1000)	Targeted click-throughs 500 ($50) 1,000 ($100) 2,500 ($200) 5,000 ($350) 10,000 ($500)	Random impressions 5,000 ($50) 10,000 ($100) 25,000 ($200) 50,000 ($350) 100,000 ($500)	Want even more? Multiply by x
Keyword(s) If applicable	Exclusive         $500 Nonexclusive         $100	Keyword
Banner location			Order total $
Web page address
Comments:	Web stats password, etc

• Charges will not be posted to advertisers credit card until banner campaign begins. All requests reviewed within 2 business days.  All orders are final.
• Advertisers will have full password protected access to the stats of their banner campaign at SURFSAFELY.COM

For more information, please contact:

SurfSafely.com
118 Belden Rd.
Burlington, CT 06013
Telephone 860-673-7431
e-mail: sales (at) surfsafely (dot) com