Sign Up Form - Print and Mail In.

Contact Details:

For billing and payment purposes only.

First Name:

____________________________

Last Name:

____________________________

Address:

____________________________

Address:

(continued)

____________________________

City:

____________________________

State / Province:

____________________________

Zip / Postal Code:

____________________________

Phone Number:

____________________________

E-mail Address:

____________________________

Desired Username:

CommerceYellowPages.com/members/username

____________________________

Desired Password:

(6-14 characters)

____________________________

Enroller's Username:

(if applicable)

____________________________

Please print this form, complete required information, and mail it with payment in full to:


Commerce Yellow Pages.
P.O. Box 273.
Appleton, WI 54912

Make check or money order payable to:

Commerce Yellow Pages

Your account will be activated when your payment is approved.

Commerce Yellow Pages
Advertising Options:
Choose 1

Select your subscription term.

 

Monthly: Silver Listing

$15 /month, per location/category

 

Yearly: Silver Listing

$180 /year, per location/category

 

 Commercial businesses $180 per year plus
1 time $30 setup fee per location, per category.

Multiple Locations / Category Listings (multiply number times cost)

___ x $180/py = ____ per year 

My Check Enclosed: payable to:
Commerce Yellow Pages
p.o. Box 273
Appleton, WI 54912

Credit Card Information:

If paying with credit card.

Card Number:

_ _ _ _ - _ _ _ _ - _ _ _ _ - _ _ _ _

Expiration Date:

_ _ / _ _ _ _

Authorized Name:

_____________________________

Billing Address:

_____________________________
_____________________________

Security Code:

(3 digits on back of card)

_ _ _

Date:

(MM / DD / YYYY )

_ _ / _ _ / _ _ _ _

I have read, understand, acknowledge and accept the legal agreement.

Signed, ___________________________________ Date: ______________