MicroNet Template

Business Information

Company Name: *

Leave Blank:

Phone: *

Email: *

Directory Category: *

Employees: *

Full-time Part-time

Comments / Questions:

Physical Address

Line 1: *

Line 2:

City: *

State: *

Postal Code: *

Country: *

Mailing Address

Same as physical address

Line 1:

Line 2:

City:

State:

Postal Code:

Country:

Social Networking:

LinkedIn Facebook Twitter YouTube Flickr

Primary Contact Information

First Name: *

Last Name: *

Title: *

Phone: *

Cell Phone:

Fax:

Email: *

Contact Preference:

Email Phone

Social Networking:

LinkedIn Facebook Twitter YouTube Flickr

Address

Same as Member Address

Line 1: *

Line 2

City: *

State: *

Postal Code: *

Country: *

Membership Options

Membership Package: *

1-5 Employees Basic Membership : $375.00
Includes Web Listing, Free e-Journal Announcements 6-10 Employees Basic Membership : $405.00
Includes Web Listing, Free e-journal Announcements 11-20 Employees Basic Membership : $480.00
Includes Web Listing, Free e-Journal Announcements 21-30 Employees Basic Membership: $540.00
Includes Web Listing, Free e-journal Announcements 31-40 Employees Basic Membership: $615.00
Includes Web Listing, Free e-journal Announcements 41-50 Employees Basic Membership: $685.00
Includes Web Listing, Free e-journal Announcements 51+ Employees, Restaurants, Hotels, and Financial Institutions:
Call us at 352-334-7100 for pricing information.

Additional Opportunities:

We will contact you with additional information.

Enhanced Web Listing : $50.00
Basic Membership PLUS, 1 Additional Category, Top placement in directory, logo on profile page, Photos & Video Options Ribbon Cutting : $100.00
Showcase your new business location with a Ribbon Cutting.

Payment Option:

Charge my credit or debit card