Bethpage Online Order Form (by mail)

Company Name/Contact Person                                                                                     Date               
Business Type                                                               Phone #                                                         

Banner Ads- There is only one business type per banner size allowed per page – an exclusive business
representation for the banner size you choose.  Priority positions are available on a first come basis.

Home Page- If available, you may order one of each size for your business type.

468 x 60 Pixels < 15K Bytes	13 wks@38.08/wk $   495 26 wks@33.85/wk $   880 52 wks@29.62/wk $1,540	$
233 x 60 Pixels < 7.5K Bytes	13 wks@30.38/wk $   395 26 wks@26.92/wk $   700 52 wks@23.85/wk $1,240	$
154 x 60 Pixels < 5.0K Bytes	13 wks@22.69/wk $   295 26 wks@20.00/wk $   520 52 wks@17.69/wk $   920	$
	TOTAL (A)	$

Category Page(s) – Which one?                                                                             
If available, you may order more than one.  Please submit a separate order form for each
Category Page selected.

468 x 60 Pixels < 15K Bytes	13 wks@28.48/wk $   370 26 wks@25.38/wk $   660 52 wks@22.21/wk $1,155	$
233 x 60 Pixels < 7.5K Bytes	13 wks@22.69/wk $   295 26 wks@20.19/wk $   525 52 wks@17.88/wk $   930	$
154 x 60 Pixels < 5.0K Bytes	13 wks@16.92/wk $   220 26 wks@15.00/wk $   390 52 wks@13.27/wk $   690	$
	TOTAL (B)	$

Create Banner- If you’re supplying either a GIF or JPEG banner ad images, there is NO CHARGE
- skip this portion.  Otherwise, there is a one-time charge, per banner ad size created.

468 x 60 Pixels < 15K Bytes	$95	$
233 x 60 Pixels < 7.5K Bytes	$80	$
154 x 60 Pixels < 5.0K Bytes	$75	$
	TOTAL (C)	$

Business Directory- If you’ve ordered a banner ad, you will receive one Basic Plus listing for each
banner ordered at NO CHARGE.  Additionally, you may order as many additional classification listings
that are relevant to your business type.  Please indicate additional classification headings here: ____________________________________________________________________________________________
____________________________________________________________________________________________ 

Basic	$119/year	$
Basic Plus	$149/year	$
Additional classification listing(s)	$  49/year x ___	$
	TOTAL (D)	$

TOTAL AMOUNT DUE (A)+(B)+(C)+(D)

$

    Make check payable and send to: Bethpage Online, P O Box 100, Bethpage NY 11714
    Or Pay by credit card:

 Acct# _  _  _  _  _  _  _  _  _  _  _  _  _  _  _  _  Exp Date _  _ / _  _

Name On Card                                                          Signature                                                    

Our technical designer will contact you upon receipt of this order form