Secure Order : Graphic Advertising Services

<html > <head> <title>Secure Order : Graphic Advertising Services</title> <script type="text/javascript" src="https://secure.cooksmill.com/form_validate.js"></script> <link rel="stylesheet" type="text/css" href="https://secure.cooksmill.com/pos.css"> </head> <body onLoad="setfocus_company()" > <div id="wrapper">  <table width=100% border=0 cellpadding=3 cellspacing=0 > <tr> <td > <img src="https://secure.cooksmill.com/images/12-banner_header.jpg" alt="Secure Server Processing for ENERGYchange.com"> </td> </tr> <tr> <td > <div class="pg_title">Secure Order : Graphic Advertising Services</div></td> </tr> </table> <table width="100%" border="0" cellpadding=0 cellspacing=2> <tr valign="top"> <td width="70%"> <form name="step1" METHOD="POST" ACTION="https://secure.cooksmill.com/cgi-bin/pos_sponsor.cgi"> <input type="hidden" name="w" value="12"> <input type="hidden" name="trace_id" value=""> <input type="hidden" name="do" value="print_mop"> <input type="hidden" name="sender_check" value=""> <input type="hidden" name="rt" value=""> <input type="hidden" name="cdnform" value="0">  <input type="hidden" name="loc" value="exchange"> <input type="hidden" name="adtype" value="mini-ad"> <input type="hidden" name="posn" value="6"> <input type="hidden" name="spid" value="991200"> <table cellpadding="2" cellspacing="1" class="table_block_1" > <tr valign="top" class="block_title"><td >Graphic Advertising Options Available</td> </tr> <tr valign="top"> <td > <table border="0" width="100%" cellpadding="2" cellspacing="1" class="ffieldsize"> <tr class="row_highlight_grey"> <td align="left"><input tabindex="41" type="radio" checked name="pos_id_item" value="001000-045::monthly" id="rad_001000-045::monthly"><label for="rad_001000-045::monthly">Mini Ad on Category Page - one month</label></td> <td align="center">$ 100 (monthly)</font></td> </tr> <tr class="row_highlight_grey"> <td align="left"><input tabindex="42" type="radio" name="pos_id_item" value="001000-045::annually" id="rad_001000-045::annually"><label for="rad_001000-045::annually">Mini Ad on Category Page - one year</label></td> <td align="center">$ 1000 (annually)</font></td> </tr> </table> </td> </tr> </table> <table cellpadding="1" cellspacing="1" class="table_block_1"> <tr> <td class="block_title" valign="top"> Your Contact and Business Information </td> </tr> <tr valign="top"> <td > <table border="0" cellspacing="1" cellpadding="1" width="100%"> <tr valign="top"> <td align="left" width="53%"> <table border="0" cellspacing="1" cellpadding="1" width="100%"> <tr valign="top"> <td valign=top class="p_text_label2" width="42%">Company :</td> <td valign=top align=left><input type="text" class="ffieldsize" tabindex="2" maxlength="125" size="25" name="company" value=""></td> </tr> <tr > <td valign=top class="p_text_label2">First Name :</td> <td valign=top align=left><input type="text" class="ffieldsize" tabindex="4" maxlength="75" size="25" name="fname" value=""></td> </tr> <tr> <td valign=top class="p_text_label2">Last Name :</td> <td valign=top align=left><input type="text" class="ffieldsize" tabindex="6" maxlength="75" size="25" name="lname" value=""></td> </tr> <tr> <td valign=top class="p_text_label2">Address :</td> <td valign=top align=left><input type="text" class="ffieldsize" tabindex="8" maxlength="75" size="25" name="address" value=""></td> </tr> <tr> <td valign=top class="p_text_label2">City :</td> <td valign=top align=left><input type="text" class="ffieldsize" tabindex="10" maxlength="75" size="25" name="city" value=""></td> </tr> <tr> <td valign=top class="p_text_label2">State/Prov. :</td> <td valign=top align=left><input type="text" tabindex="6" class="ffieldsize" maxlength="75" size="25" name="province" value=""></td> </tr> <tr> <td valign=top class="p_text_label2"><abbr title="Zip Code or Postal Code">Zip/PCode :</abbr> </td> <td valign=top align=left><input type="text" tabindex="14" class="ffieldsize" maxlength="25" size="25" name="pcode" value=""></td> </tr> <tr> <td valign=top class="p_text_label2">Country :</td> <td valign=top align=left colspan="3"><font > <select tabindex="8" style="font-size:70%;" name="country" size=1> <option value="">--- Select Country ---</option> <option value="Canada">Canada</option> <option value="USA">USA</option> <option value="">------------------------------</option> <option value="Afghanistan">Afghanistan</option> <option value="Aland Islands">Aland Islands</option> <option value="Albania">Albania</option> <option value="Algeria">Algeria</option> <option value="American Samoa">American Samoa</option> <option value="Andorra">Andorra</option> <option value="Angola">Angola</option> <option value="Anguilla">Anguilla</option> <option value="Antarctica">Antarctica</option> <option value="Antigua And Barbuda">Antigua And Barbuda</option> <option value="Argentina">Argentina</option> <option value="Armenia">Armenia</option> <option value="Aruba">Aruba</option> <option value="Australia">Australia</option> <option value="Austria">Austria</option> <option value="Azerbaijan">Azerbaijan</option> <option value="Bahamas">Bahamas</option> <option value="Bahrain">Bahrain</option> <option value="Bangladesh">Bangladesh</option> <option value="Barbados">Barbados</option> <option value="Belarus">Belarus</option> <option value="Belgium">Belgium</option> <option value="Belize">Belize</option> <option value="Benin">Benin</option> <option value="Bermuda">Bermuda</option> <option value="Bhutan">Bhutan</option> <option value="Bolivia">Bolivia</option> <option value="Bosnia and Herzegovina">Bosnia and Herzegovina</option> <option value="Botswana">Botswana</option> <option value="Bouvet Island">Bouvet Island</option> <option value="Brazil">Brazil</option> <option value="British Indian Ocean Territory">British Indian Ocean Territory</option> <option value="Brunei Darussalam">Brunei Darussalam</option> <option value="Bulgaria">Bulgaria</option> <option value="Burkina Faso">Burkina Faso</option> <option value="Burundi">Burundi</option> <option value="Cambodia">Cambodia</option> <option value="Cameroon">Cameroon</option> <option value="Canada">Canada</option> <option value="Cape Verde">Cape Verde</option> <option value="Cayman Islands">Cayman Islands</option> <option value="Central African Republic">Central African Republic</option> <option value="Chad">Chad</option> <option value="Chile">Chile</option> <option value="China">China</option> <option value="Christmas Island">Christmas Island</option> <option value="Cocos (Keeling) Islands">Cocos (Keeling) Islands</option> <option value="Colombia">Colombia</option> <option value="Comoros">Comoros</option> <option value="Congo">Congo</option> <option value="Cook Islands">Cook Islands</option> <option value="Costa Rica">Costa Rica</option> <option value="Croatia">Croatia</option> <option value="Cuba">Cuba</option> <option value="Cyprus">Cyprus</option> <option value="Czech Republic">Czech Republic</option> <option value="Denmark">Denmark</option> <option value="Djibouti">Djibouti</option> <option value="Dominica">Dominica</option> <option value="Dominican Republic">Dominican Republic</option> <option value="Ecuador">Ecuador</option> <option value="Egypt">Egypt</option> <option value="El Salvador">El Salvador</option> <option value="Equatorial Guinea">Equatorial Guinea</option> <option value="Eritrea">Eritrea</option> <option value="Estonia">Estonia</option> <option value="Ethiopia">Ethiopia</option> <option value="Falkland Islands (Malvinas)">Falkland Islands (Malvinas)</option> <option value="Faroe Islands">Faroe Islands</option> <option value="Fiji">Fiji</option> <option value="Finland">Finland</option> <option value="France">France</option> <option value="French Guiana">French Guiana</option> <option value="French Polynesia">French Polynesia</option> <option value="French Southern Territories">French Southern Territories</option> <option value="Gabon ">Gabon </option> <option value="Gambia">Gambia</option> <option value="Georgia">Georgia</option> <option value="Germany">Germany</option> <option value="Ghana">Ghana</option> <option value="Gibraltar">Gibraltar</option> <option value="Greece">Greece</option> <option value="Greenland">Greenland</option> <option value="Grenada">Grenada</option> <option value="Guadeloupe">Guadeloupe</option> <option value="Guam">Guam</option> <option value="Guatemala">Guatemala</option> <option value="Guinea">Guinea</option> <option value="Guinea-Bissau">Guinea-Bissau</option> <option value="Guyana">Guyana</option> <option value="Haiti">Haiti</option> <option value="Heard Island and Mcdonald Islands">Heard Island and Mcdonald Islands</option> <option value="Holy See (Vatican City State)">Holy See (Vatican City State)</option> <option value="Honduras">Honduras</option> <option value="Hong Kong">Hong Kong</option> <option value="Hungary">Hungary</option> <option value="Iceland">Iceland</option> <option value="India">India</option> <option value="Indonesia">Indonesia</option> <option value="Iran">Iran</option> <option value="Iraq">Iraq</option> <option value="Ireland">Ireland</option> <option value="Israel">Israel</option> <option value="Italy">Italy</option> <option value="Ivory Coast">Ivory Coast</option> <option value="Jamaica">Jamaica</option> <option value="Japan">Japan</option> <option value="Jordan">Jordan</option> <option value="Kazakhstan">Kazakhstan</option> <option value="Kenya">Kenya</option> <option value="Kiribati">Kiribati</option> <option value="Korea, North">Korea, North</option> <option value="Korea, South">Korea, South</option> <option value="Kuwait">Kuwait</option> <option value="Kyrgyzstan">Kyrgyzstan</option> <option value="Laos">Laos</option> <option value="Latvia">Latvia</option> <option value="Lebanon">Lebanon</option> <option value="Lesotho">Lesotho</option> <option value="Liberia">Liberia</option> <option value="Libya">Libya</option> <option value="Liechtenstein">Liechtenstein</option> <option value="Lithuania">Lithuania</option> <option value="Luxembourg">Luxembourg</option> <option value="Macao">Macao</option> <option value="Macedonia">Macedonia</option> <option value="Madagascar">Madagascar</option> <option value="Malawi">Malawi</option> <option value="Malaysia">Malaysia</option> <option value="Maldives">Maldives</option> <option value="Mali">Mali</option> <option value="Malta">Malta</option> <option value="Marshall Islands">Marshall Islands</option> <option value="Martinique">Martinique</option> <option value="Mauritania">Mauritania</option> <option value="Mauritius">Mauritius</option> <option value="Mayotte">Mayotte</option> <option value="Mexico">Mexico</option> <option value="Micronesia">Micronesia</option> <option value="Moldova">Moldova</option> <option value="Monaco">Monaco</option> <option value="Mongolia">Mongolia</option> <option value="Montserrat">Montserrat</option> <option value="Morocco">Morocco</option> <option value="Mozambique">Mozambique</option> <option value="Myanmar">Myanmar</option> <option value="Namibia">Namibia</option> <option value="Nauru">Nauru</option> <option value="Nepal">Nepal</option> <option value="Netherlands">Netherlands</option> <option value="Netherlands Antilles">Netherlands Antilles</option> <option value="New Caledonia">New Caledonia</option> <option value="New Zealand">New Zealand</option> <option value="Nicaragua">Nicaragua</option> <option value="Niger">Niger</option> <option value="Nigeria">Nigeria</option> <option value="Niue">Niue</option> <option value="Norfolk Island">Norfolk Island</option> <option value="Northern Mariana Islands">Northern Mariana Islands</option> <option value="Norway">Norway</option> <option value="Oman">Oman</option> <option value="Pakistan">Pakistan</option> <option value="Palau">Palau</option> <option value="Palestinian Territory">Palestinian Territory</option> <option value="Panama">Panama</option> <option value="Papua New Guinea">Papua New Guinea</option> <option value="Paraguay">Paraguay</option> <option value="Peru">Peru</option> <option value="Philippines">Philippines</option> <option value="Pitcairn">Pitcairn</option> <option value="Poland">Poland</option> <option value="Portugal">Portugal</option> <option value="Puerto Rico">Puerto Rico</option> <option value="Qatar">Qatar</option> <option value="Reunion">Reunion</option> <option value="Romania">Romania</option> <option value="Russia">Russia</option> <option value="Rwanda">Rwanda</option> <option value="S Georgia and The S Sandwich Isis">S Georgia and The S Sandwich Isis</option> <option value="Saint Helena ">Saint Helena </option> <option value="Saint Kitts and Nevis">Saint Kitts and Nevis</option> <option value="Saint Lucia">Saint Lucia</option> <option value="Saint Pierre and Miquelon">Saint Pierre and Miquelon</option> <option value="Saint Vincent and The Grenadines">Saint Vincent and The Grenadines</option> <option value="Samoa">Samoa</option> <option value="San Marino">San Marino</option> <option value="Sao Tome and Principe">Sao Tome and Principe</option> <option value="Saudi Arabia">Saudi Arabia</option> <option value="Senegal">Senegal</option> <option value="Serbia and Montenegro">Serbia and Montenegro</option> <option value="Seychelles">Seychelles</option> <option value="Sierra Leone">Sierra Leone</option> <option value="Singapore">Singapore</option> <option value="Slovakia">Slovakia</option> <option value="Slovenia">Slovenia</option> <option value="Solomon Islands">Solomon Islands</option> <option value="Somalia">Somalia</option> <option value="South Africa">South Africa</option> <option value="Spain">Spain</option> <option value="Sri Lanka">Sri Lanka</option> <option value="Sudan">Sudan</option> <option value="Suriname">Suriname</option> <option value="Svalbard and Jan Mayen">Svalbard and Jan Mayen</option> <option value="Swaziland">Swaziland</option> <option value="Sweden">Sweden</option> <option value="Switzerland">Switzerland</option> <option value="Syria">Syria</option> <option value="Taiwan">Taiwan</option> <option value="Tajikistan">Tajikistan</option> <option value="Tanzania">Tanzania</option> <option value="Thailand">Thailand</option> <option value="Timor-Leste">Timor-Leste</option> <option value="Togo">Togo</option> <option value="Tokelau">Tokelau</option> <option value="Tonga">Tonga</option> <option value="Trinidad And Tobago">Trinidad And Tobago</option> <option value="Tunisia">Tunisia</option> <option value="Turkey">Turkey</option> <option value="Turkmenistan">Turkmenistan</option> <option value="Turks And Caicos Islands">Turks And Caicos Islands</option> <option value="Tuvalu">Tuvalu</option> <option value="USA">USA</option> <option value="Uganda">Uganda</option> <option value="Ukraine">Ukraine</option> <option value="United Arab Emirates">United Arab Emirates</option> <option value="United Kingdom">United Kingdom</option> <option value="Uruguay">Uruguay</option> <option value="Us Minor Outlying Islands">Us Minor Outlying Islands</option> <option value="Uzbekistan">Uzbekistan</option> <option value="Vanuatu">Vanuatu</option> <option value="Venezuela">Venezuela</option> <option value="Vietnam">Vietnam</option> <option value="Virgin Islands, British">Virgin Islands, British</option> <option value="Virgin Islands, U.S.">Virgin Islands, U.S.</option> <option value="Wallis and Futuna">Wallis and Futuna</option> <option value="Western Sahara">Western Sahara</option> <option value="Yemen">Yemen</option> <option value="Zambia">Zambia</option> <option value="Zimbabwe">Zimbabwe</option> </select>  </td> </tr> </table> </td> <td align="left" > <table border="0" cellspacing="1" cellpadding="1" width="100%"> <tr valign="top"> <td valign=top class="p_text_label2" ><abbr title="Include your Ext. if you have one">Telephone :</abbr> </td> <td valign=top align=left><input type="text" tabindex="18" class="ffieldsize" maxlength="50" size="25" name="tel" value=""></td> </tr> <tr> <td valign=top class="p_text_label2">800/888 :</td> <td valign=top align=left><input type="text" tabindex="20" class="ffieldsize" maxlength="50" size="25" name="tel_free" value=""></td> </tr> <tr> <td valign=top class="p_text_label2">Fax:</td> <td valign=top align=left><input type="text" tabindex="22" class="ffieldsize" maxlength="50" size="25" name="fax" value=""></td> </tr> <tr> <td valign=top class="p_text_label2">Email :</td> <td valign=top align=left><input type="text" tabindex="24" class="ffieldsize" maxlength="75" size="25" name="sender" value=""></td> </tr> <tr> <td valign=top class="p_text_label2"><abbr title="Website address, URL or Home Page, e.g. http://www.mycompanyname.com">Home Page :</abbr></td> <td valign=top><input type="text" tabindex="26" class="ffieldsize" maxlength="75" size="25" name="url" value=""></td> </tr> <tr> </tr> </table> </td> </tr> <tr> <td colspan="2"> <hr width="100%" size="1"> </td> </tr> <tr> <td class="p_text_label2" style="text-align:left;">Which Best Describes Your Company or Organization:</td> <td valign="top" class="p_text_label2" style="text-align:left;">Company Profile (Description):</td> </tr> <tr valign="top"> <td align="right"> <table class="p_text_label2" width="95%" border="0" cellpadding="1" cellspacing="1"> <tr valign="top"> <td align="left"><input class="ffieldsize" tabindex="32" type=radio name="type" checked="checked" value="trade"></td> <td align="left">Trade related business</td> </tr> <tr valign="top"> <td align="left"><input tabindex="32" class="ffieldsize" type=radio name="type" value="equip"></td> <td align="left">New equipment manufacturer</td> </tr> <tr valign="top"> <td align="left"><input tabindex="32" type=radio class="ffieldsize" name="type" value="trade_eq"></td> <td align="left">Used equipment reseller</td> </tr> <tr valign="top"> <td align="left"><input tabindex="32" type=radio name="type" class="ffieldsize" value="equip_s"></td> <td align="left">Service related business</td> </tr> <tr valign="top"> <td align="left"><input tabindex="32" type=radio name="type" class="ffieldsize" value="trade_dispatch"></td> <td align="left">Transportation Service </td> </tr> <tr valign="top"> <td align="left"><input tabindex="32" type=radio name="type" class="ffieldsize" value="assn"></td> <td align="left">Industry Association (member based) </td> </tr> <tr valign="top"> <td align="left"><input tabindex="32" type=radio name="type" class="ffieldsize" value="pub"></td> <td align="left"> Industry Publication </td> </tr> <tr valign="top"> <td align="left"><input tabindex="32" type=radio name="type" class="ffieldsize" value="exch"></td> <td align="left">Information & Materials Exchange</td> </tr> <tr valign="top"> <td align="left"><input tabindex="32" type=radio name="type" class="ffieldsize" value="sites"></td> <td align="left">Miscellaneous Website</td> </tr> </table> </td> <td align="right"> <textarea tabindex="34" name="descript" rows="10" cols="25"></textarea> </td> </tr> </table> </td> </tr> </table> <p align=center><input type="submit" value="PROCEED TO NEXT STEP" name="B1" tabindex="100" class="btn" > </form></p> </td> <td> <table cellpadding="2" cellspacing="1" class="formmarketing_table_block_1" > <tr valign="middle"> <td > </td> </tr> </table> <table cellpadding="2" cellspacing="1" class="formmarketing_table_block_1" style="border:0px"> <tr valign="top" class="formmarketing_block_title"><td >Features</td> </tr> <tr valign="top"><td class="formmarketing_text"> <ul > <li class="formmarketing_text_ul">We provide clients with the ability to locate a visible graphic advertisement on any of the highly categorized web pages within ENERGYchange.com</li> <li class="formmarketing_text_ul">The highly organized structure of ENERGYchange.com ensures that very specific types of prospects will view the advertisements and be given the ability to contact the advertiser directly.</li> </ul> <div style="text-align:right;"><a href="https://www.energychange.com/web/sponsor.html">Learn more</a></div> </td> </tr> </table> <table cellpadding="2" cellspacing="1" class="formmarketing_table_block_1" style="border:0px"> <tr valign="top" class="formmarketing_block_title"><td >How it Works</td> </tr> <tr valign="top"><td class="formmarketing_text"> <ul> <li class="formmarketing_text_ul">Graphic advertisements link to an advertiser's directory listing where a page visit counter tracks the number of visits.</li> <li class="formmarketing_text_ul">Directory listings contain the full contact information of the advertiser, and where appropriate, a dynamic reply form is also present. All reply form leads are emailed directly to the advertiser for follow-up.</li> </ul> <div style="text-align:right;"><a href="https://www.energychange.com/web/sponsor.html">Learn more</a></div> </td> </tr> </table> </td> </tr> </table> <p> <table width="100%" cellpadding=2 cellspacing=2> <tr> <td colspan=2> <hr color="#008080" noshade="noshade"> </td> </tr> <tr valign="top"> <td align=left width="50%"> <div class="p_note_light"> SECURE ON-LINE TRANSACTIONS<br> </div> </td> <td > <div class="p_note_light" style="text-align:right;"> CREDIT CARDS ACCEPTED</strong></font><br> <img src="https://secure.cooksmill.com/images/visam2.gif" alt="VISA" hspace="2"> <img src="https://secure.cooksmill.com/images/mcm2.gif" alt="Master Card" hspace="2"> <img src="https://secure.cooksmill.com/images/amexm2.gif" alt="American Express" hspace="2"> </div> <div style="font-size: 0.7em; font-weight: normal; color: #000080; text-align: right;">For Assistance, call : 519 767 2913 |  <a target="_BLANK" href="https://secure.cooksmill.com/terms_conditions.html" style="text-decoration: none;color:#008080;" title="Click here to view the terms and conditions related to online purchases">Terms & Conditions</a> </td> </tr> </table> <br> <font size=1>Page Ref.: </font><br> </div>  </body></html>

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Secure Order : Graphic Advertising Services