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Complete the following form if you are interested in advertising your site or company via the SAFE Market.

Company Details
Company Name
Street Address
Street Address
City
State/County/District
Country
Zip/Postcode
Telephone
Fax
Contact person
E-mail
URL

Site/Product Information

Please Describe the nature of your site (no more than 250 characters)
Choose the option that approximates access to your site/product the best
Visits per week (approx)
Please describe the people that access your site (no more than 250 characters)

Please tell us how you found out about this site (If a search engine describe which and the keyword you searched on)

The following section will help us advise you on pricing your banners and getting started with SAFE

Have you advertised with banners before? Yes No

Your monthly budget proposed for SAFE advertising: $

  • We regret that the minimum acceptable budget currently amounts to US$ 1000.00

  • My products/services are:

    My average order value is: $

    The address of my order form is:

    I have a secure order form:
    Yes No Don't know

    Our order form generates a thank you page
    Yes No Don't know

    I would like you to design an animated banner for us FREE of charge
    Yes No


    SAFE User Information

    Preferred Login Name:
    Password:
    Confirm Password: