Your name:   

Company:        (if applicable)

Phone:          

Email:            

ADVERTISEMENT DETAILS:

Please attach your graphic image here:         

Or if you do not have a graphical advertisement prepared, we can create a generic text-based ad for you.  If you would prefer this, enter the text of your message (20 words or less) below:
                                                                      

To where will your ad be hyperlinked?           

PAYMENT INFORMATION:  (Billing address must exactly match the address on your credit card statement.)

On which page will your display ad appear?	(Please select a show) Global Talk Radio's Home Page - US$45.00 per month A Story to Tell - US$25.00 per month Best Internet Sites - US$25.00 per month Beyond Reality - US$25.00 per month Bobby Likis Car Clinic - US$25.00 per month Business 101 - US$25.00 per month Calling All Authors - US$25.00 per month Crystalis Callings - US$25.00 per month Demystifying Non-Profits - US$25.00 per month Dirty Little Secrets with Craig & Mike - US$25.00 per month Disability News & Views Radio Show - US$25.00 per month Family Matters - US$25.00 per month Feng Shui Today - US$25.00 per month GenderTalk - US$25.00 per month Healthy Choices - US$25.00 per month Indie Business Radio - US$25.00 per month Insightful Astrology - US$25.00 per month Jewel's Way - US$25.00 per month Journeys with Rebecca - US$25.00 per month New Age Radio - US$25.00 per month Podcast Radio Show - US$25.00 per month Public Access Radio - US$25.00 per month Ready for Romance - US$25.00 per month Sally's Midnight Hour - US$25.00 per month Savvy Mommy - US$25.00 per month Secrets to Financial Success - US$25.00 per month The BigMoney - US$25.00 per month The Great Shift - US$25.00 per month The Jackie Jones Challenge - US$25.00 per month The Lillian Cauldwell Show - US$25.00 per month The Savvy Trader - US$25.00 per month Wake Up America - US$25.00 per month Whispers - US$25.00 per month Your On Live - US$25.00 per month Who Wants to be a RADIO STAR? - US$25.00 per month
Will you auto-renew your display ad?	(Please select one.) YES - Automatically renew my advertisement each month. (Cancellation requires a 30-day notice.) NO - This is a one-time purchase for one month only.
Type of credit card:	(Please select one.) Visa Mastercard American Express Discover
Credit Card Number:
Expiration (MM/YY):
CVV2 Security:	(For your security, this is the 3-digit number on the back of most credit cards.)
Name as it appears on your card:
Your billing street address:
City:
State:
Zip:
Country:	Afghanistan Albania Algeria Andorra Angola Antigua & Barbuda Argentina Armenia Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bhutan Bolivia Bosnia & Herzegovina Botswana Brazil Brunei Bulgaria Burkina Faso Burma/Myanmar Burundi Cambodia Cameroon Canada Cape Verde Central African Republic Chad Chile China Colombia Comoros Congo Costa Rica Croatia Cuba Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic East Timor Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Fiji Finland France Gabon Gambia Georgia Germany Ghana Greece Grenada Guatemala Guinea Guinea-Bissau Guyana Haiti Honduras Hungary Iceland India Indonesia Iran Iraq Ireland Israel Italy Ivory Coast Jamaica Japan Jordan Kazakhstan Kenya Kiribati Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Mauritania Mauritius Mexico Micronesia Moldova Monaco Mongolia Morocco Mozambique Namibia Nauru Nepal Netherlands New Zealand Nicaragua Niger Nigeria North Korea Norway Oman Pakistan Palau Panama Papua New Guinea Paraguay Peru Philippines Poland Portugal Qatar Romania Russia Rwanda Saint Kitts & Nevis Saint Lucia Saint Vincent & the Grenadines Samoa San Marino Sao Tome & Principe Saudi Arabia Senegal Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa South Korea Spain Sri Lanka Sudan Suriname Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Togo Tonga Trinidad & Tobago Tunisia Turkey Turkmenistan Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States Uruguay Uzbekistan Vanuatu Vatican City Venezuela Vietnam Yemen Yugoslavia Zambia Zimbabwe

Terms:
1.  This is a non-refundable purchase.
2.  If you select auto-renewal, your first month will be prorated and you agree that your credit card will be charged the full monthly amount on or before the first day of
     each subsequent month.  To cancel auto-renewal, you must write to [email protected].  If you do not receive a confirmation of cancellation of auto-
     renewal within 2 business days, you must send another email or call our office.  Cancellations must be placed at least 30 days in advance.
3.  Prices are subject to change.  If you select auto-renewal, we will notify you at least 30 days in advance of any changes in the advertising rates.  If we do not hear
     from you with 7 calendar days of such notice, you will have accepted the price changes and your monthly rate will be adjusted accordingly for subsequent months.
4.  We do not guarantee a particular position in which your advertisement will appear, nor do we guarantee how many others ads will appear on the same page.
5.  We reserve the right to suspend or cancel individual advertising campaigns at any time and at our own discretion.  In the event that we (GTR) cancel your advertising
     campaign, we will refund your unused balance immediately.

You must agree to the above terms:     (Please select one.) Yes, I agree. No, I do not agree.
 

        (Upon approval, a confirmation will be sent to you via email usually within 1-2 business days.)