PART 1: Your Details

Etrex ID (if any):
E-mail:
Organization:
Contact Name:
Position:
Address:
City/Town:
County/State:
Post/Zip Code:
Country:
Telephone:
Fax:

Have you got a Web Site ? Yes No

If the answer to the above is "Yes" please state your site URL:

Is your Web Site hosted by Etrex ? Yes No

Part 2: Your Charity Appeal
Please state the name and purpose of the charity you are sponsoring:

Does the charity have a Web Site ? Yes No

If the answer to the above is "Yes" please state the site URL:

For how many weeks do you want the appeal to run?

Is there a 'ready-made' appeal logo on disk.... Yes No
....or at the charity's Web Site?: Yes No

If the answer to both of the above is "NO" and you require us to scan or design a banner/web box please tick this box:

Part 3: Payment

Check how much your appeal costs from the following list and enter the total amount in the boxes below. Deduct 10% if we are hosting your site. PLEASE ADD VAT.

Banners & Boxes	Weekly Cost (£stg / US$)
static image animated 1 image animated 2 images animated 3 images	£15 / US$25 £25 / US$45 £45 / US$75 £65 / US$110
Add: One-off logo scan/design (if needed): £25 / US$40

Total: £ (words):

You need to pay the total cost now for work to start. How do you wish to pay?
Credit/Debit Card Cheque
(If by cheque please print out this form and forward it with your remittance)

Please debit my credit/debit card with the above amount:

Card Type (click one): Visa Mastercard Switch Delta
Card Number: Expiry Date: /
Name on Card:
Address (if different from above)

Part 4: Other
How did you learn about Etrex ?:

You may enter any additional details below. Use the scrollbar if necessary; PLEASE hit 'return' after each line

Please make a final check of the details you have entered above. You can change entries by deleting data or re-selecting from lists; (entries CANNOT be changed after submission).

To clear your ENTIRE order push this button:

If your order details are correct please read the following carefully and then push the agreement button:

Advertising Terms and Conditions

The following terms together with our General Terms and Conditions or GTAC form the entire Agreement under which we undertake to provide advertised services and products. All persons ordering such services and products are deemed to have read and understood this Agreement, including the said GTAC.

1. All orders must be accompanied by full payment of the total amount due. No services or products shall become due until such payment has been received. Payments are not refundable
2. You are responsible for getting all source material to us in the right medium and in good time for work to proceed. We will not be liable for damage to original material. You are advised to send us copies only.
3. We reserve the right to reject anything which is against the operational policies set out in our GTAC, or which we judge to be unsuitable or below acceptable advertising standards.
4. Before we publish your advertisement we will either send you a copy or direct you to a WWW address at which it could be viewed.
   If you are unhappy with anything we will check this against the agreed specification. If we have not followed the specification then the omission will be rectified immediately. If however you wish to change some aspect then this will be costed as additional work. You are therefore advised to check the specification carefully BEFORE submitting an order.

Thank you for your custom. If you have provided an e-mail address you should receive an acknowledgement within 24 hours.

Please remember to send copies (preferably on disk) of your promotional material and any graphics you want in your advert to:

Etrex Web Design Team
Paragon Centre, Australia Road
London W12 7PH, England.