Services & Products Directory - Company Profile Order Form

Services & Products Directory - Company Profile - Annual Fee $500 USD
Includes Premium Listings For Each Category Your Company Serves

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Mailing & faxing instructions are included below.

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Important - Write Clearly or Type In

ANNUAL BILLING INFORMATION This WILL NOT appear online.

Do you have a paid Basic or Premium listing on ActiveSET.org right now?		No, this is a new order.
		Yes, we want to upgrade to a Company Profile. Please prorate our current account with an extended annual renewal date.

Send our receipt and placement confirmation to this e-Mail address:

___________________________________________________________________________________________________________
(This address will NOT be given, sold or leased to 3rd Parties)

Billing Street or P.O. Box: ___________________________________________________________________________________

City: ______________________________________________________________ State/Prov: ____________ Zip: _____________

Free Logo
Preparation:

Scan our logo from our website
We are sending a digital logo attached to e-Mail addressed to webmaster@activeset.org
We are mailing a scannable color logo with our order (artwork cannot be returned)

COMPANY PROFILE & PREMIUM LISTING INFORMATION This WILL appear online.

Company Name: ____________________________________________________________________________________________

Address ___________________________________________________________________________________________________

City: ______________________________________________________________ State/Prov: ____________ Zip: _____________

Mailing Address (If Different): ________________________________________________________________________________

City: ______________________________________________________________ State/Prov: ____________ Zip: _____________

Phone (Area code): ______________________________________ Fax (Area code): ____________________________________

Toll Free: ___________________________________________________ or N/A

Web Address: http:// ______________________________________________________________________________ or N/A

Reply to e-Mail Address: ____________________________________________________________________________________

Type Of Business: Manufacturer Supplier Rental All

Provide a SHORT 1-2 Line Description (40 Words) of Your Services or Products:

___________________________________________________________________________________________________________

___________________________________________________________________________________________________________

___________________________________________________________________________________________________________

PREMIUM LISTING PLACEMENT PAGES

Select All Categories That Apply:
Please select the categories your company is actively serving only.

Ambient Air Monitors
Analytical Labs
Analyzers - Gas
Calibration Gases
CEMS
Combustion Engineers
Data Acquisition/CEMS Sytems

Dilution Probes/Systems
Dry Ice
EHS Software
Emissions Trading/Brokers
Environmental Eng. Firms
Glassware Repair
Handheld Sniffers

Isokinetic Sampling Trains
Lab Supplies
Pollution Control Equipment
Professional Affiliations/Pubs.
Reagents & Chemicals
Rental Test Equipment
Sampling Pumps

Suggest a New Category: ______________________________________________________________________________________

Provide a bulleted list of the Products and/or Services your company offers:
e.g. Analyzers, Calibration Gases, Process Equipment, Lab Analyses, Consulting Services, etc.

Provide a short paragraph describing your COMPANY OVERVIEW:

Provide a short paragraph describing your COMPANY EXPERTISE:

Provide a short paragraph describing your COMPANY SPECIALTIES:

PAYMENT OPTIONS The annual fee is non-refundable after your order has been placed on ActiveSET.org.

OPTION 1 - Pay By Check
Mail the completed form with a U.S. Check or Money Order in U.S. Funds for the $500 annual fee payable to:
ActiveSET.org 3335 NW 47th Terrace Gainesville, Florida 32606

OPTION 2 - Pay By Credit Card

Mail the completed form to:
ActiveSET.org 3335 NW 47th Terrace Gainesville, Florida 32606

Fax the completed form to:
(352) 375-3759

I authorize Emissions Schematics to bill my credit card $500 (USD) for the annual fee. ActiveSET.org is owned and
operated by Emissions Schematics. Your credit card will be billed as "Emissions Schematics"

Cardholder's First and Last Name as it appears on the front of the card:

____________________________________________________________________________________________

Credit Card Number:

____________________________________________________________________________________________

Expiration Date - Month: _____________ .. Year: __________

Thank You ! ActiveSET.org will process your order immediately upon receipt.
By submitting this order you agree to the terms and conditions of the ActiveSET.org Advertising Services Agreement
ActiveSET.org Customer Service: order@activeset.org