Order Form.  Do a simple print screen to obtain paper form for your use.

OFFICIALLY WISCONSIN(sm) - Internet Advertising Order Form
                                       Mail or fax to:
                                       Officially Wisconsin - Sales Dept
                                       2425 N. 95th St - Suite 200
                                       Wauwatosa, WI  53226
                                       Voice/Fax: (800) 330-9867       

[1]  * * * * * * * * * SELECT DESIRED SERVICES  * * * * * * * 

+++++++++++++++++
+ BUSINESS CARD + Place your text advertising message on the Internet.
+++++++++++++++++

Company Name:___________________________Location(s):_________________

By-line/Brief description:___________________________________________

Business Hours: _____________________________________________________

Name of person on Business Card (optional: __________________________
Address (3 lines):                Phone #: __________________________
________________________________  Fax #: ____________________________
________________________________  Alternate Phone #: ________________
________________________________  E-mail Address: ___________________

Up to 4 lines of additional descriptive text about company (business,
services, brands, etc)(100 characters/line):
______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

                         * * * * * * * * * * * * 
+++++++++++++++++++++
+ BUSINESS WEB LINK + Link your existing Web site. 
+++++++++++++++++++++

Company Name:__________________________ Location(s):_________________

Text or by-line for BUSINESS WEB LINK:_______________________________

Your Web Page address: ______________________________________________
(Example: www.abcbusiness.com) 


SELECT LOCATIONS FOR BUSINESS CARD/BUSINESS WEB LINK
List the geographic locations you want to target and the advertising cat-
egories for each.  Choose: National, Wisconsin or specific community/county,
and use any category typically found in the consumer or business-to-business
Yellow Pages of your telephone book.  (We currently target communities with
a minimum population of 2,000 and other select communities.  See our web 
site at:  www.offwis.com)

 
GEOGRAPHIC LOCATIONS               ADVERTISING CATEGORY
____________________________  _________________________________

____________________________  _________________________________

____________________________  _________________________________

____________________________  _________________________________

____________________________  _________________________________

EXAMPLE one identical ad, 3 locations, one category:

GEOGRAPHIC LOCATIONS          ADVERTISING CATEGORY
----------------------------  ---------------------------------
  __Wisconsin__                 __Restaurants__
  __Madison__                   __Restaurants__  
  __Dane County__               __Restaurants__  

                        * * * * * * * * * * * * 
++++++++++++++++++++++
+ BANNER ADVERTISING + Your graphics targeting whole community 
++++++++++++++++++++++

You will be contacted by phone or email, or call us for details.  Rate 
is $12/mo. with 8 month minimum.  Payment due when your ad graphics are 
ready for placement.

COMMUNITIES                    # OF MONTHS (8 month minimum)   START DATE
____________________________  ______________________________  ___________

____________________________  ______________________________  ___________

____________________________  ______________________________  ___________

                        * * * * * * * * * * * * 
++++++++++++++++++++
+ BUSINESS WEB MAP +  Map showing your business location 
++++++++++++++++++++  (for any quantity of Business Card or Business Web Link)

                        * * * * * * * * * * * * 
++++++++++++++++++++++++
+ DONATION DESIGNATION +  20% of new advertising sale donated to your chosen
++++++++++++++++++++++++  Wisconsin community or non-profit group.

Name of group: ______________________  Address: _____________________________

[2]  * * *  COMPLETE ORDER AND PAYMENT INFORMATION  * * * 

Name: __________________________________________________

Company: _______________________________________________

Mailing Address (street, city, state, zip code): 
______________________________________  Phone #: (____)_____________________
______________________________________  E-mail address: ____________________
______________________________________

                    NUMBER OF     NUMBER OF           @ PER
                    CATEGORIES    LOCATIONS      QTY   YEAR    TOTAL
                    ===========  ===========     ===  ======   ======                                        

BUSINESS CARD......  ________  x  _________   =  ____ @$24.00  $_____

BUSINESS WEB LINK..  ________  x  _________   =  ____ @$24.00  $_____

Add BUSINESS MAP................................ ____  $18.00  $_____  

                                                         TOTAL $_____

METHOD OF PAYMENT

__ Check enclosed                Credit card # _______________________
                                 
__ Purchase order (company       Expiration date: ____________
   letterhead)
__ Master Card                   Cardholder name: ____________________
__ VISA                          (Please print)

Welcome to Officially Wisconsin!  How did you hear about us?
__ Word-of-mouth      __ Presentation
__ Brochure           __ Web Site
                                                               
Your Salesperson: _______________________                      ~U06D032