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PAWEB2.com - "All States" FAX_FORM - Internet Promotion
PO Box 126, Apollo, PA 15613-1026

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  • Fax this information to (888) 724-8218
  • Receive 200-800 Permanent Links
  • Full-Page website that acts as and/or mirros your web site
  • Search Engine Registration

    • YOUR FULL NAME (First Middle Initial Last):
    		 BUSINESS / INSTITUTION NAME:
    YOUR EMAIL ADDRESS:


    YOUR URL ADDRESS (if applicable):
    		PHONE NUMBER:
    HOME / BUSINESS / INSTITUTION ADDRESS:
    		 CITY:
    STATE:
    		 ZIP CODE:

    Payment Plan - Visa/Master/Discover Credit Card
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    300 Permanent Links - $9.95
    400 Permanent Links - $11.95
    600 Permanent Links - $18.95
    700 Permanent Links - $20.95
    800 Permanent Links - $22.95
    		 16-Digit Credit Card Number


    Credit Card Expiration Date (Month/Year)
    Enter the details of your products/services here...

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