Reurn To HomeStack Testing Firm Premium Listings - Annual Fee $300 USD
For Firms With More Than One Office Location
Mailing & faxing instructions are included below.

Important - Write Clearly or Type In
ANNUAL BILLING INFORMATION This WILL NOT appear online.


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)

PREMIUM LISTING INFORMATION This WILL appear online.
Main Office Listing:

Company Name: ____________________________________________________________________________________________


Main Office Address: ________________________________________________________________________________________


City: ______________________________________________________________ State/Prov: ____________ Zip: _____________


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


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


Reply to e-Mail Address: ____________________________________________________________________________________


Premium Listings for Additional Offices:
(Enter the address, city, state, zip, phone & fax numbers for each. Attach a separate sheet if needed)

1) Address: _______________________________________________________________________________________________


City: _____________________________________________________________ State/Prov: ____________ Zip: _____________


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


2) Address: _______________________________________________________________________________________________


City: _____________________________________________________________ State/Prov: ____________ Zip: _____________


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




3) Address: _______________________________________________________________________________________________


City: _____________________________________________________________ State/Prov: ____________ Zip: _____________


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


4) Address: _______________________________________________________________________________________________


City: _____________________________________________________________ State/Prov: ____________ Zip: _____________


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


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 $300 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 $300 (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