interbiznet.com

Print and Fax form to 415.380.8245 or Call 415-377-2255
interbiznet, 303 Ross Drive, Mill Valley, CA 94941                        Date: _____________

     (   )  Package 1 $2,000 - Promotional Discount $495.00
             12 month listing on interbiznet directory listings.
             Detail Company Information.
             Complete Contact infomation.

     (   )  Package 2 $3,500.00 - Promotional Discount $1200.00
             12 month listing on interbiznet directory listings.
             Detail Page with company description.
             Hyperlinked banner to company website.
             Complete Contact infomation.

     (   )  Package 3 $7,500.00 - Promotional Discount $2,400.00
             12 month listing on interbiznet directory listings.
             Detail Page with company description.
             Info Form included directly forwards request.
             Hyperlinked banner to company website.
             Complete Contact infomation.
             Solo page ownership no advertisers.

Payment Total: $ ____________

Contact: _______________________ Company: __________________________________

Credit Card # ___________________________________________ Expiration: ___________

Address: __________________________________________________________________

City: _____________________________ State: ______________ Zip Code: _____________

Phone: _______________________________ Fax: _________________________________

Name on Card: ______________________________________________________________

Authorization: _________________________________________ Date: ________________
(Signature)                                      NOTE: Promotional Discount available thru August 31, 2005.