Sign Up For a Partner Listing

Please fill out this ENTIRE form in order to obtain a Partner Listing here at

Fields Marked with an * are required

Company Information

Company Name *
Local Number *
Fax Number
Toll Free Number
Address *
City *
State *
Zip *
Website URL *
Email *
Billing Contact
Internet Contact

Payment Method

Credit Card
  • Addional $10.00 service fee applies.
  • Please fax a copy of the signed check to 352-401-0353.

Plan Selection

   $79.00 Credit Card
   $89.00 Check
   $948 Credit Card
   $1068 Check

Credit Card Information

* I hereby authorize / NetSource Technologies to charge this credit card until I notify / NetSource Technologies of my intent to cancel in writing 30 days in advance.

Type of Card *
Card Number *
Expiration Date *  
Name on Card *
Address *
City *
State *
Zipcode *

Terms and Conditions

Advertiser shall notify / NetSource Technologies 30 days in advance of its intent to cancel. All months are to run consecutively. Charges will accrue beginning on the first day that the ad is posted on Sales tax to be added where applicable.


Advertiser hereby agrees to indemnify / NetSource Technologies for all expenses it may incur to enforce collection of any amount due and Advertiser agrees to pay all collection costs, reasonable attorney’s fees and court costs incurred in such collection.


Advertiser agrees that the liability of / NetSource Technologies, if any, for any omissions, mistakes, errors and/or defects in said advertisement shall in no event exceed the cost of the space occupied by the error but not exceeding the amount of advertising fees actually paid by Advertiser to / NetSource Technologies.


Advertiser further acknowledges by execution of this agreement that it has not relied upon any promise, statement or representation other than as contained herein. All invoices are due and payable upon receipt. Unless change is received, ad from previous month will be repeated.

* I hereby warrant that I have read the terms and conditions and that I have full power and authority to sign as an agent for the Advertiser.