Order Form
#6:  - On-line Brochure (Mini-web)

1.  Date of Submission

-- mm/dd/yy

2.  Contact information:  

First name
Last name
Middle initial
Title
Business Name
Street address
Address (cont.)
City
State/Province
Zip/Postal code
Country
Business Phone
Reservations Phone
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

3.  Start Date:

Enter the start date for your listing to be published :

5.  Business Description:

Please enter the description of your business 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 Two-Page On-Line Brochure (Mini-Web).

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 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
PO Box 1909
Columbia Falls, MT 59912

Credit Card:  Please submit your credit card information by telephone: 406-892-2940 or 206-715-1704, or regular mail. The information must include the following:

Account Number  __________________   Expiration Date: _____

Card ID Number (back side of card):  _____

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 406-892-2940 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 website.

Sincerely,

Jack C. High
Editor and Publisher
GoNorthwest.com
PO Box 1909
Columbia Falls, MT 59912
Voice: 406-892-2940 or 206-715-1704