S.M.O.T. Advertising

Customer Information

Full Name:    (Service User)
Street Address:    (ex: '1234 Elm Street')
City:   (ex: 'Boston')
State/Province:    (ex: 'MA')
Zip/Postal Code:    (ex: '02120')
Country:    (ex: 'USA' or 'Canada')
Home Phone:    (used for voice verification)
E-Mail:    (no anonymous/free e-mail services)

 

Banner Page
 

Banner Location

Sign-Up Icon

 

Payment Information


NOTE:  ALL CHARGES WILL APPEAR UNDER OUR SISTER COMPANY :
"KIRE" ON YOUR CREDIT CARD STATEMENT.

 

Select Payment Type: 
CardHolder Name: 
Credit Card Number : ---
Expiration Date (ex. 06/12): 

Due to the high volume of fraud, we require that you input the following information which will assure us that you actually have this credit card in your possession and are authorized to use it.

Name of bank issuing card is your Credit Card's bank, this information can also be found on the back of your credit card:

Credit Card Customer Service Phone Number is the Phone Number of your card's customer service line, located on the backside of your credit card:

Billing Method and Length

Select Billing Method:

Miscellaneous  Information

Location of your banner:

URL your banner should link to:
Questions, Comments or Special Contact information, please let us know now:


 

 
 

To Submit your banner subscription to SMOTASS click 'Submit' ONCE below.