Love Burke Living - Platinum Membership Enrollment Form

Love Burke Living - Platinum Membership

Membership Enrollment Form
Platinum Membership Directory Listing ~ Just $249.95/year
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Filter Type:

Email:

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Company Name:

Street

Unit:

City:

Zip Code:

P.O. Box:

City:

Zip Code:

Business Category: Choose Primary & up to 10 Other Categories
(Not All Choices Guaranteed To Be Listed But By Submitting, We Will Be Able To Better Determine Best Placement)

10.

Located within a major commerce center:

(if other, please list)

First:

Last:

Title:

Contact Name (If Different)

Phone:

Toll Free:

Fax Line:

Cell Ph:

Home:

Web Site:

Alt Page:

Email Address:

GPS Coordinates:

Receive Monthly Newsletter:

Yes No

Your business motto/slogan and information (up to 75 words) about your business.

Attach Photos:

# 1.

# 2.

# 3.

# 4.

# 5.

Additional Information about where we can find text, photos and/or graphics to use in your listing

It is our desire to keep this directory up to date. We will gladly make corrections, additions and/or deletions of text at no additional cost.

Your membership is guaranteed renewable for life at this low rate as long as there is no lapse in service.

Love Burke Living