Electrolysis Referral Directory

If you would like to place a *banner advertisement on-line with The Electrolysis Referral Directory please review our pricing, then fill out and submit this page, or you can print and fax or mail this application back to us:

*If you would like to list your services with The Electrolysis Referral Directory, please use this application

E-mail: elecbanner@bworks.com
Fax: (707) 202-2178
Mail: BWORKS.com, 26720 Affirmed Drive, Wesley Chapel, FL 33544
And, please, feel free to call at: (813) 973-9872

Please fill out the following form, and press submit:

Company Name:

Contact Name:

Telephone:

E-Mail:

Web Address:

Address:

City: State: Zip or Postal Code:

I would like my ad placed on the following page(s):

Home Page
Directory of Electrologists
Supplies & Equipment

please contact for individual state page & Forum Advertisements

I have read the pricing terms (below), and agree to the terms. Please put my ad up as soon as you receive it!

Please select one:

VISA

Master Card Credit Card #: Exp. Date: or Mail Payment to: BWORKS.com, 26720 Affirmed Drive, Wesley Chapel, FL 33544

I'm sending my banner ad

A 6-month Rotation Banner is: $500/page - Main pages only - please contact for individual state page & Forum Advertisements