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Reservation Form

To reserve your listing with USAJobTV.com Inc., please fill out the form below and click on the submit button.

Company Name: *
Contact Name: *
Address Street 1: *
Address Street 2:
City: *
Zip Code: *	(5 digits)
State:
Daytime Phone: *
Evening Phone:
Company Website: *
Email: *
Week Start Date for ad:*
Number of Weeks: *
TV & Web Total $: *	=#of weeks X $1,550
	I want a Web Video $299 or $599
	I don't want a Business Profile Video or I have my own
	Use a photo instead of the Business Profile Video
Survey question: $50
JobSeeker Page Sponsor: $50
Job Fair Podcast: $200
Podcast Promo: $50
Web Video:	($299 basic or $599 premium)
Grand Total: *
	I have a Photo of my business already
	I would like you to take a Photo of my business at no charge
Payment Terms:	Credit card or billing available.
Credit Card Number:
Exp Month - Year 00/00:
Security Code:
Name on Card:
Credit Card Type MC or Visa	Please type "MC" or "Visa"
Promo Code:
Comments:	Enter Job Description here!

You will receive a confirmation within 12 hours.
If you have any questions, please contact us at 913-232-9113

TERMS & CONDITIONS

Upon your submission, USAJobTV.com Inc reserves the time and date agreed upon on this form and will purchase TV airtime to display your ad. For this reason all payments are NON-REFUNDABLE if the ad is cancelled for any reason or if the date is changed AFTER the deadline.