1.  Date of Submission

2.  Contact information:  

First name
Last name
Middle initial
Title
Business Name
Street address
Address (cont.)
City
State/Province
Zip/Postal code
Country
Phone
Toll-free
Fax
E-mail
URL

2.  Business Type

Please indicate the type of business.
(For example, B&B, Restaurant, Hotel, Museum, Theatre, Outfitter, Ranch, Tour Operator, Resort, Guide, Chamber of Commerce, Newspaper...)

Type of Business

4.  Start Date:

Enter the start date for your On-line brochure to be published :

5.  Business Description:

Please enter the description of your business, and other wording for your page in the box below:

6.  Image (a logo, photo or illustration):

If you wish to include images in your on-line brochure, please send them attached to an email message, or, tell us which images to use from your web site or brochure.

7.  Additional Comments:

Please add any additional comments you would like to make in the box below:

Congratulations!  You have now completed the Order Form for a linked listing with a one-paragraph description.

6.  Submit Your Listing Information

Click the "Submit Form" button below to submit your information online (click the button just once).  Or, if you prefer, print this page and send it to us via Fax (509-838-0871) or regular mail.

7.  Payment

You may submit your payment of $125.00 in US funds by check or credit card.

*Please note the above plans are subject to a surcharge when your business web site is not under it's own domain name. An example would be http://www.thirdparty.com/yourbusiness. This surcharge does not apply when your business has it's own domain name such as http://www.yourbusiness.com. For more information please contact Go Northwest!

If by check, please make your check payable to Go Northwest in the amount of $125.00 in US funds.  The regular mail address is:

Go Northwest
P.O. Box 8037
Spokane, WA 99203

If you wish to pay by credit card, then please us your credit card information by telephone: 509-838-2377 or 206-715-1704; Fax: 509-838-0871; or regular mail.  The information must include the following:

Account Number  ________________________      Expiration Date: __________

Name on the Card: _________________________

Mail Address as it appears on your credit card statement:

Street: __________________________

City: ___________________State: __________  ZIP: ___________

Please feel free to contact us by email at info@gonorthwest.com, or, telephone us at 509-838-2377 or 206-715-1704 during normal business hours if you have questions or wish additional information.

Thank you for your participation on Go Northwest!  We look forward to carrying your listing and bringing more visitors to your web site.

Sincerely,

Jack C. High
Editor and Publisher
GoNorthwest.com
P.O. Box 8037
Spokane, WA 99203
Voice: 509-838-2377 or 206-715-1704
Fax: 509-838-0871