Name: ___________________________________________________________


 Business Name: ___________________________________________________________


       Address: ___________________________________________________________


          City: ___________________________________________________________


         State: _______________________________Zip:________________________


      Phone(s): ___________________________________________________________


       Link to: ___________________________________________________________


   Your E-mail: ___________________________________________________________


   Description: ___________________________________________________________
(up to 254 char
  for index ad)
                ___________________________________________________________


                ___________________________________________________________

  Marquee Text 
up to 200 char: ___________________________________________________________
 
                ___________________________________________________________

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 Module 1 Text 
up to 200 char: ___________________________________________________________

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 Module 2 Text 
up to 200 char: ___________________________________________________________

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 Module 3 Text 
up to 200 char: ___________________________________________________________

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 Module 4 Text 
up to 200 char: ___________________________________________________________

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 Module 5 Text 
up to 260 char: ___________________________________________________________

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 Module 6 Text 
up to 200 char: ___________________________________________________________

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Use this area to compute your total. Texas residents must
include the sales tax in their total.
                                           Price of ad:   $38.00

                   Texas residents add 8.25% sales tax:    $3.14


                            Grand Total for this order: ______________

Please check payment method:       

Money order: _______  Check: _______  Mastercard:_______  Visa:_______


 Account Number:   _________________________________Exp:______________


 Your Signature:   ___________________________________________________

Mail this completed order form along with your money order, check, or credit card number to:

Peachtree Sales
733 West Miller Road
Garland, Texas 75041

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