Mexonline.com LLC Credit Card Payment via FAX
Please print and fill out this page and FAX to (U.S.) 619-303-2091

Directory Listing Web Page Ad (prices per year)
Check off which services you are paying for below:
1/1 Web Page Listing $150 ( 1 graphic, 1 page + logo)
4/2 Web Page Listing $200 (4 graphics, 2 pages + logo)
6/2 Web Page Listing $250 (8 graphics, 3 pages + logo)
8/3 Web Page Listing $300 (8 graphics, 3 pages + logo)

Classified Advertising (price as noted)
Photo RE Classified $50/6 months (add a photo to your real estate classified)
Photo Rental Classified $50/6 months (add a photo to your vacation rental classified)

CONTACT INFORMATION

Full name:	__________________________________
Title:	__________________________________
Company name:	__________________________________
Area Code + Phone#:	__________________________________
Billing Address:	__________________________________
City, state and zip code:	__________________________________
Country:	__________________________________
Email address (required):	__________________________________
Your Current Home Page:	__________________________________
Sales rep name, if any:	__________________________________

PAYMENT INFORMATION
Are you a new customer or renewing an existing service?
     New Customer         Renewal

Credit Card Number:	__________________________________
3-digit Security Code (back of card):	__________________________________
Expiration Date (mm/yy):	__________________________________
Name on the Card:	__________________________________

IMPORTANT - Add up the total to be charged to your card: $_______________

Please describe any special requests on your order.