Subscriber Registration Form (Announcement) |
Ad Profile: |
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Item Title: |
(Ad Name) |
Ad Description
(services, products): |
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Time / Attendance: |
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What cards accepted for payment your establishment?
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Visa
Master
Dinners
Amex
Hipercard
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Promotion Guide: Your Customer Benefits by Coupon Exchange |
Description of Promotion:
(eg 25% discount)
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Location and Contact |
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Number: |
Neighborhood:
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Complement: |
(reference) |
City: |
State:
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ZIP Code: |
(just numbers) |
Phone: |
(XX) (XXXX-XXXX) |
Secondary Phone: |
(opcional) |
Mobile: |
(opcional) |
Fax: |
(opcional) |
Web Site: |
(opcional)
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e-mail: |
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password: |
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repeat password: |
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Keywords Search to the Guide and Search Engines Sites |
Word List:
(ex pizza, disk pizza, where to eat, dinner, wood burning,
disk, deliveries)
can be registered up to 100 words separated by commas with each word |
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Plan Announcement and Payment |
Entering the state: |
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Insertion City: |
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(monthly) |
Period of Contract: |
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Payment: |
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Social Reason: |
(just companies) |
CNPJ: |
(just numbers) |
Responsible Name: |
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C.P.F/ID: |
(just numbers) |
Note:
(comments)
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(opcional) |
Promotional Code: |
(opcional) |
How did you find?: |
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Subscriber Agreement: |
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Payments made via credit card or transfer will be processed on the next page by clicking the "Pay with PayPal"
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