Advertising Submittal Form for Chiro.Org

To Become a Sponsor of,
please fill out the form below:

This information will be sent to Chiro.Org when you “click” on the
“I have read the contract” button, found at the bottom of this page.

Are you ready to place your order?
Please check one... it is required. ----->
Yes, I am ready, and here is my information
No, I need additional info to make a decision
Please select the type of advertisement desired:
Banner ad - 6 months: $250 (includes free text ad listing)       Review our rate card below
Banner ad - 1-year: $400 (includes free text ad listing)

My email address. required
My Real Name is. required
My Phone is.
My Fax is...

How did you hear of www.Chiro.Org / who referred you?
Banner or Link/Text ad information

NOTE:   Your TEXT Advertisment will be based upon this information.
Contact Name
Company Name (will appear as shown)
Company Address (will appear as shown)
City State Zip (will appear as shown)
Company Phone
(Be sure to include 800 numbers and/or area code)
Company Fax
My website URL (will appear as shown)
Email address for the ad to link to
If you have a banner.gif online, put the URL for it here
(See the Banner ad graphic requirements below)
Description: Enter a sixty-word maximum description of your products, services, and contact information...
this description will appear on our
Sponsors Page.  
Alternate text: This is the text which will display in place of your banner graphic if a surfer has graphics turned off in his/her browser. You may enter up to 80 characters.
Additional comments to our Sales Department manager:

The amount of the check you mail us will determine the type of advertisement you selected, [link or banner] AND the length of time the advertisement is to run on the Chiro.Org server.

Our Advertising Rate Card:

Have two options:

         (1)   Six-months minimum six-month commitment:
         Total   $250/ 6 months
         ...add $100 Setup fee, if we create your "static" banner graphic (total $350).
         ...add $125 Setup fee, if we create your "animated" banner graphic (total $375).

         (2)   One year discounted annual rate:
         Total   $400/year
         ...add $100 Setup fee, if we create your "static" banner graphic (total $500).
         ...add $125 Setup fee, if we create your "animated" banner graphic (total $525).

Banner Ad Graphic Requirements:

Designed at 420x60 pixels, and
no more than 20K maximum size.

The Banner Setup fee is applicable if only we create your banner, or make any requested changes to your existing banner: Cost is $50-75 (static or animated graphic). There is a $25 handling fee to switch your graphic or text ad with a replacement during your subscription period.

Once we have received and reviewed your application to sponsor we will notify you. Please do NOT send payment until you've received a confirmation from us.

Make your check/money order, in $US currency, payable to:

Chiropractic Resource Organization

And then mail your check to:

Michael Beattie
231 Dearborn Blvd
Waterloo, ON N2J 4Y4


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