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Pisources.com
Fax or Mail Application
Company Name ________________________________________________________________
Company Street Address _________________________________________________________
City/State/Zip
__________________________________________________________________
County/Province
________________________________________________________________
Primary Phone# ________________________________________________________________
Fax Number __________________________________________________________________
Other Phone# _________________________________________________________________
Cell Phone# ___________________________________________________________________
Contact Person & Title
__________________________________________________________
Email _______________________________________________________________________
Website _____________________________________________________________________
License# (if applicable)
__________________________________________________________
Insured (yes/no)
_______________________________________________________________
Services Offered ______________________________________________________________
___________________________________________________________________________
Membership Orgs ____________________________________________________________
Additional Comments __________________________________________________________
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Listing Price:
$29.95 Standard Listing per year.
$74.95 Full Page Ad per year.
$100.00 Multiple Standard Listings per year (5 States or Countries).
Fax & Phone: (253) 243-0015
pisources@comcast.net
Warm Sand Web Productions
1517 S. 27th Street
Renton, WA 98055
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