Online Ad Form

Company: E-mail:
Contact Name: Website:
Address: Phone:
City/State/Zip: Personal Phone:
Number of Categories: Price per Category (Monthly):
$
Qty Ad Description One-Time Build Fee Monthly Recurring Fee Exp. Date
$
$
$
$
$
$
$
$
$
$

I understand that payment to be collected upon signing is $, which includes a one-time programming fee and the first month’s advertising fee. This agreement is for months, with a total contract value of $. I agree to pay $ per month until paid in full.

I personally and unconditionally guarantee full and prompt payment of all advertising and related service fees associated with this agreement. I acknowledge that I have read and agree to the terms and conditions at www.surflocal.net/terms.html. Surflocal.Net may cancel any advertisement if payment is more than 30 days past due. In the event of nonpayment, I agree to pay all outstanding fees within 15 days of cancellation and understand that I am responsible for any collection costs, including court costs, reasonable attorney fees, and past-due interest at 1.5% per month.

All payments are final and non-refundable; returned checks incur a $35 NSF fee. I waive my right to dispute or issue chargebacks for services rendered. Advertising purchased does not guarantee search engine placement and is part of Surflocal’s broader marketing effort.

Authorized Signature of Advertiser Type Name of Advertiser
Signature of Authorized Reseller Date