Mediam Basic Submission Form - 159 per annum

SITE DETAILS

* Please remember that when entering the pages for your website, only the page name is required (e.g. page.htm) and not the full address (e.g. http://www.website.com/page.htm). Also, please note that the 4 pages are ADDITIONAL pages within your site as the home page is automatically submitted with the URL field.
URL of your site:
Page 1:
Page 2:
Page 3:
Page 4:
Title for your site:
Choose a category for your site:
Keywords for your site:
(please seperate keywords with a comma)
MAX 200 CHARACTERS
Email address to which you want the submission report to be sent each month:
Please choose how often you want your website submitted Every 2 weeks Every 4 weeks
RANK TRACKING

Please enter the keywords you would like to receive rank tracking reports on in the boxes below. For meaningful results, please enter keywords that are prominent within your website.
Keyword 1:
Keyword 2:
Keyword 3:
Keyword 4:
Keyword 5:

 PERSONAL DETAILS


First Name :
Last Name :
Email Address :
Company Name :
Address :
Town :
County: :
Post Code :
Country :
Daytime Phone :
Fax :

 

COST

159.00 +VAT (186.83)

PAYMENT DETAILS

Cheques must be made payable to Mediam Internet Services and sent to:
Mediam Internet Services
Siddeley House
50 Canbury Park Rd
Kingston
KT2 6LX