Pay Per Click Request Form (128 bit encryption)

Please complete the following information to enroll in Spiegel & Utrera's pay per click advertising program on AmeriLawyer.com. After receiving your contact and ad information, and after we process your billing information, we will contact you no later than the following business day to finalize your ad details.

Name:

E-Mail:

Address:

Phone:

City:

Fax:

State:

Mobile Phone:

Zip Code:


Name of Business:

Zip Code:

Business Address:

Business Phone Number:

City:

Business Title:

State:

Business Category:

Description line 1 (maximum 40 characters)
Description line 2 (maximum 40 characters)
Description line 3 (maximum 40 characters)
Display URL (Ex. https://www.yourbusinesswebsite.com):

Destination URL (Ex. https://www.yourbusinesswebsite.com):

Will You be Using an Image? (Image Size: 200 X 60) Yes No
If yes, information on how to send us your logo will be provided after submission of this order form.

 
Business name
Business address
City, State Zip
1 (800) 603 - 3900
 		Description line1
Description line2
Description line3.
www.amerilawyer.com
 
Ad Preview

Click Here to view sample Ad

Select a Payment Option:

PayPal American Express Visa Mastercard Discover


CREDIT CARD DETAILS
Enter a Credit Card Number:

Enter Credit Card Expiration Date:
Month    Year

PayPal Email Address:
PayPal Payment Instructions: If you are going to process your order with a PayPal account, provide us with the email address associated with your account. No charges are ever processed or requested until we speak with you first.

 

AN INITIAL NON-REFUNDABLE CHARGE OF $250.00 WILL BE CHARGED TO YOUR CREDIT CARD OR REQUESTED THROUGH PAYPAL FOR THIS SERVICE. Your account will be debited a category based dollar minimum pay per click fee (CPC). For categories that have more than one sponsor, you can bid a higher cost per click to obtain the top position. Once your ad starts running on our site, we make no claims, as to how much traffic your Ad will receive. Our staff will notify you prior to your funds running out for any additional funds.

 
    

We have taken the necessary measures to guarantee that any client information submitted to our secure server will not be intercepted by unauthorized parties. Without you having to download any additional software, your information is automatically protected with a 128 bit encryption certificate. Double click on the Gold Padlock on the bottom right of your browser's screen to bring up details of our SSL Security certificate.