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Homeschool Mall ® Link Insertion Form
YES! Sign me up for a link from Homeschool World!
Name ____________________________________ Title _________________
Product Advertised _______________________________________________
Company Name _____________________________________________________
Address __________________________________________________________
City _________________________ State ______________ Zip ________
Phone ________________ Fax _____________ Email _________________
Your URL (web site address):______________________________________
Preferred Categor(ies) ___________________________________________
15 words or less describing your site: ___________________________
__________________________________________________________________
| I want a Link for |
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| (_) 3 months, $99 |
(_) |
| (_) 6 months, $199 |
(_) |
| (_) 1 year, $299 |
(_) |
| (_) 2 years, $499 |
(_) |
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Coupon Code _______________________________
MC/VISA/AmEx/Discover # ____-____-____-____ Exp. Date _____/_____
I have read and agree to Homeschool World's terms and conditions.
Signature ________________________________________Date _____/_____
Questions? Call us at (636) 343-6786 or fax (636) 225-0743.
Return with payment to:
Home Life, Inc., 1731 Smizer Mill Rd., Fenton MO 63026-2635. Fax: (636) 225-0743
Subsequent payments will be billed or charged at current rates as the old payment expires.
Cancel anytime and receive a pro-rated refund, less $50 set-up fee.
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