The ODL Website Banner Ad or Mini Ad Banner Application Form

Please print this form, complete the information requested and mail to the address at the bottom of this page.

I hereby submit my application for a banner ad placement on the ODL Website.
FIRST NAME: LAST NAME:
ADDRESS:
CITY: STATE: ZIP CODE:
COMPANY:
PHONE: (___) FAX: (___)
EMAIL:
WEB SITE ADDRESS: http://
HOW DID YOU HEAR ABOUT THE ODL Website?
SIZE OF AD:
Banner 468 x 60 Banner 125 x 125 Square Button
Banner 120 x 240 Vertical Banner Banner 120 x 60 Button 2
Banner 120 x 90 Button 1 Banner 88 x 31 Micro Button
Please Enter Your Start Date for AD:
PAYMENT TYPE (please circle):
CHECK OR CREDIT CARD
CREDIT CARD INFORMATION:
TYPE OF CARD (please circle):
VISA OR MASTERCARD
CREDIT CARD NUMBER:
CREDIT CARD EXPIRATION DATE:
NAME ON CREDIT CARD :
Submit this application along with your payment to the following address:

The OSHA Defense League
24760 W. Via Del Llano
Calabasas, CA 91302

or FAX to (818) 224-3217

A representative from the ODL will contact you regarding how to deliver your banner ad graphics.

I certify that the above information is true, correct and complete to the best of my knowledge. I authorize the ODL to verify the above information.

____________________________________   ________________________
(Applicant Signature)                          (Date)
  

Return to ODL Advertising Information
Return to ODL