ANN News: News Application Form

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NEWS DELIVERY APPLICATION FORM

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Please provide all the necessary information in the form below. We will contact you as soon as possible with rate and setup information.

Account Information is used for internal purposes only and is never released to any third parties at anytime. All fields must be filled. Votre information est gardée strictement confidentiellement. Elle n'est communiquée à personne d'autre. Remplissez toutes les cases ci-dessous.

First Name - Prénom:
Last Name - Nom:
Street Address - Rue:
City - Ville:
State/Etat/Province:
Postal Code - Code postal
Country - Pays:
Home Telephone - Domicile:
Work Telephone - Bureau:
Fax number - Numéro fax:
E-mail:
Company - Entreprise
Domain name (site) where the news will be used. Nom de domaine (site) où seront lues les nouvelles.	http://www.
Choose your news delivery option - Choisissez votre option de livraison des nouvelles.
Are the news to be used on a commercial or non-commercial Web site? Les nouvelles seront utilisées sur un site coomercial / non-commercial?	Commercial Non-Commercial
Where did you hear about us? Où avez-vous pris connaissance de notre existence?
Description of your company or organization Special Comments and Requests? Please include all pertinent details about your business or organization and how you intend to use our news. Requêtes et commentaires spéciaux? Ajoutez tous les détails sur votre entreprise ou organisation et sur la manière dont vous comptez utiliser nos nouvelles.

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