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MoverDirectory Listing Order Form

Listing Request & Authorization Form

LISTING INSTRUCTIONS: Please complete the following on-line Listing Request & Authorization Form to submit your Listing Information. If you prefer, you may PRINT the form and MAIL it along with your payment to:

MOVER DIRECTORY
96 Chalet Court
Lake Saint Louis, MO 63367

Business or Service Description & Web Contact Information
Email
Web Site Address - http://
3 Descriptive Lines about Your Business or Services	(this will be displayed with your listing)

FEES - $100.00 YEARLY / per Category / per Location
You must select at least 1 category
	Household Movers Commercial Movers Storage Truck Rentals Cartons & Supplies Piano Movers International Movers Auto Transport
Confirm the number of categories requested @ $100.00 yearly / per Category / per Location A LIMITED number of 468x60 pixels BANNERS are available on various parts of Mover-Directory. To discuss this tremendous advertising opportunity for your services please contact us at: BANNER INFORMATION

BILLING INFORMATION SECTION
Company OR Business Name
First Name
Last Name
Address
City & State
Zip+4 Code
Phone	( )
Fax	( )

PAYMENT METHOD
	BY INVOICE - DUE WITHIN 30 DAYS
	Pay by Credit Card Complete Credit Card Information below

CREDIT CARD INFORMATION
Required Items below are only applicable if you are paying by Credit Card.
Name on Card
Type
Number
Expiration	(MM/YYYY ex: 03/2005)

MOVER DIRECTORY 96 Chalet Court Lake Saint Louis, MO 63367 Fax: (636) 692-4805 SYSTEMS ADMINISTRATOR SYSTEM INFORMATION MOVER DIRECTORY
Copyright © 1999 - 2009 / MOVER DIRECTORY. While every attempt is made to maintain security and confidentiality of information transmitted across the Internet, we disclaim any and all liability should any entity intercept the information contained on this form and use it for any purpose other than what it is intended for.