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internal use only:
Received: ___/___/___ Category:
________________
Added: ___/___/___ by: ___ Checked: ____
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Company: __________________________________
Contact: __________________________________ Title:
___________________________
Address: _________________________________________________________________________
Town, State: __________________________________
Zip: _____________
Phone: __________________________________ Fax: ___________________________
Email: ___________________________
Listing
Information:
800# Phone: __________________________________ Contact Person: _______________________
Website: http://___________________________________________________________________
Email for Reservation / Info request:
______________________________________________________
Reservation Page url:
http://_____________________________________________________________
Listing Type: ___ Photo Listing
___2 page brochure listing
___4 page brochure listing ___
Custom
Do you offer commissions for bookings from travel agents? __No
__Yes ____%
Do you mail brochures / information upon request? ___No ___ Yes
Category Requested: ___________________________ ( If left blank we will select the most
appropriate category ).
Keyword(s) or description about your business (up to 50 words):
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________
Please briefly
describe which page(s) or photo(s) of your brochure you would like included in
your listing.
If you mark the brochure itself, please include a second blank brochure.
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________
Billing Information: __
Monthly __Quarterly __Yearly
___ Annual Prepaid Rate
__ Pay by Credit Card __ MC
__VISA Name on Card:________________________________________
Card #:
______________________________________________ Exp: ___/___/___
Ordered by:
(please print): ________________________ Signature: ____________________ Date:
________
www.islandsource.com Toll-free: 800-908-9764
P.O. Box 699, Volcano, Hawaii 96785
Phone/Fax: 808-967-8617
email: advertise@islandsource.com