BrantfordWeb.net
A Galganov & Associates web site
We link only to businesses physically located in Brant County.

To request a business link on the BrantfordWeb.net Website, please complete the form below and fax it to:
Galganov & Associates @ (519) 752-3088
Or, phone us at (519) 752-5381

Renewal New Subscription

Company name: ______________________________________________

Your name: __________________________________________________

Address: ____________________________________________________

City: _______________________________________________________

Province: _________________________ Postal Code: _______________

E-mail: _____________________________________________________

Telephone No: (_____) __________________

Date: ________________________________

Web Site Title: ______________________________________________

Web Site URL: http://_________________________________________

Web Site Description (maximum 15 words):

___________________________________________________________

___________________________________________________________

___________________________________________________________

One Year Subscription = CAD 24.00 + 1.68 GST (7%) = $25.68
G.S.T. #888433661

Credit Card Type: VISA MasterCard

Name on Card:______________________________________________

Cardholder Address:__________________________________________

___________________________________________________________

Credit Card #:_______________________ Expiration Date:___________

Last 3 digits of number printed on back of the credit card:____________

Signature:______________________________ Amount: $____________


Note: Your account will only be debited once your link has been accepted. We retain the right to refuse links to websites (at our own discretion and without justification) of and/or with links to web sites of misleading, illegal and/or non-family oriented content. Website content must fall within acceptable guidelines through the contract period (family safe, etc). Links will be removed without compensation if content is changed to illegal, misleading or non-family safe content after your link is accepted.

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