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<meta name="GENERATOR" content="Microsoft FrontPage 5.0">
<meta name="ProgId" content="FrontPage.Editor.Document">
<meta http-equiv="Content-Type" content="text/html; charset=windows-1252">
<title>Confirming Job Posting Insertion Form</title>
</head>
<body background="http://www.powermarketers.com/images/pma-bg3.gif">
<font SIZE="2">
<table border="0" cellpadding="0" cellspacing="0" style="border-collapse: collapse" bordercolor="#111111" width="876" id="AutoNumber1">
<tr>
<td width="224"> </td>
<td width="475">
<form method="POST" action="_vti_bin/shtml.dll/jobform.htm" onSubmit="" webbot-action="--WEBBOT-SELF--">
<!--webbot bot="SaveResults" s-email-format="TEXT/PRE" s-email-address="[email protected]" b-email-label-fields="TRUE" s-builtin-fields="REMOTE_NAME REMOTE_USER HTTP_USER_AGENT" startspan --><input TYPE="hidden" NAME="VTI-GROUP" VALUE="0"><!--webbot bot="SaveResults" endspan i-checksum="43374" --><font SIZE="2"><p><br>
<br>
<img src="http://www.powermarketers.com/images/jobsbnr.gif" hspace="5" vspace="5"
width="393" height="86"></p>
<p align="center"> </p>
<div align="left"><p><font size="4" color="#003366" face="Arial"><strong><b>CONFIRMING JOB
POSTING INSERTION FORM</b> </strong></font></p>
</div><p><font size="2" face="Arial"><font color="#111111">The following advertising insertion contract is subject to the PMA
Jobs Site </font> <a href="http://www.powermarketers.com/jobrates.htm">
<font color="#111111">standard terms and
conditions</font></a></font></p>
<div align="left"><p><font size="2" face="Arial" color="#111111">(Please Complete all of the Fields)</font></p>
</div><table border="0" width="468">
<tr>
<td colspan="2" bgcolor="#C0C0C0" valign="middle"><b>
<font size="2" face="Arial">CUSTOMER INFORMATION</font></b></td>
</tr>
<tr>
<td width="150" height="25" valign="middle">
<font size="2" face="Arial">First Name:</font></td>
<td width="318"><font size="2"><input type="text" size="30" name="a. First Name"><br>
</font></td>
</tr>
<tr>
<td width="150" height="25" valign="middle">
<font size="2" face="Arial">Last Name:</font></td>
<td width="318"><font size="2"><input type="text" size="30" name="b. Last Name"><br>
</font></td>
</tr>
<tr>
<td width="150" height="25" valign="middle">
<font size="2" face="Arial">Title:</font></td>
<td width="318"><font size="2"><input type="text" size="30" name="c. Title"><br>
</font></td>
</tr>
<tr>
<td width="150" height="25" valign="middle">
<font size="2" face="Arial">Agency:</font></td>
<td width="318"><font size="2"><input type="text" size="30" name="d. Agency"><br>
</font></td>
</tr>
<tr>
<td width="150" height="25" valign="middle">
<font size="2" face="Arial">Company:</font></td>
<td width="318"><font size="2"><input type="text" size="30" name="e. Company"><br>
</font></td>
</tr>
<tr>
<td width="150" height="25" valign="middle">
<font size="2" face="Arial">Department:</font></td>
<td width="318"><font size="2"><input type="text" size="30" name="f. Department"><br>
</font></td>
</tr>
<tr>
<td width="150" height="25" valign="middle">
<font size="2" face="Arial">Street Address:</font></td>
<td width="318"><font size="2"><input type="text" size="30" name="g. Street Address"><br>
</font></td>
</tr>
<tr>
<td width="150" height="25" valign="middle">
<font size="2" face="Arial">City:</font></td>
<td width="318"><font size="2"><input type="text" size="30" name="h. City"><br>
</font></td>
</tr>
<tr>
<td width="150" height="25" valign="middle">
<font size="2" face="Arial">State:</font></td>
<td width="318"><font size="2"><input type="text" size="30" name="i. State"><br>
</font></td>
</tr>
<tr>
<td width="150" height="25" valign="middle">
<font size="2" face="Arial">Zip / Postal Code:</font></td>
<td width="318"><font size="2"><input type="text" size="30" name="j. Zip - Postal Code"><br>
</font></td>
</tr>
<tr>
<td width="150" height="25" valign="middle">
<font size="2" face="Arial">Country:</font></td>
<td width="318"><font size="2"><input type="text" size="30" name="k. Country"><br>
</font></td>
</tr>
<tr>
<td width="150" height="25" valign="middle">
<font size="2" face="Arial">Phone:</font></td>
<td width="318"><font size="2"><input type="text" size="30" name="l. Phone"><br>
</font></td>
</tr>
<tr>
<td width="150" height="25" valign="middle">
<font size="2" face="Arial">Fax:</font></td>
<td width="318"><font size="2"><input type="text" size="30" name="m. Fax"><br>
</font></td>
</tr>
<tr>
<td width="150" height="25" valign="middle">
<font size="2" face="Arial">Email:</font></td>
<td width="318"><font size="2"><input type="text" size="30" name="Email"><br>
</font></td>
</tr>
<tr>
<td colspan="2" bgcolor="#C0C0C0" valign="middle" width="150"><b>
<font size="2" face="Arial">AD
INFORMATION</font></b></td>
</tr>
<tr>
<td width="150" height="25" valign="middle"></td>
<td width="318"></td>
</tr>
<tr>
<td width="150" height="25" valign="middle">
<font size="2" face="Arial">Ad Package (<i>required</i>):</font></td>
<td width="318"><font face="Arial" size="2"><select name="q. Ad Package" size="1">
<option selected>Click Arrow - Select From Pull-Down Menu</option>
<option value="Budget Contract">Budget Contract</option>
<option value="Basic Contract">Basic Contract</option>
<option value="Contract A">Contract A</option>
<option value="Contract B">Contract B</option>
<option value="Contract C">Contract C</option>
<option value="Contract D">Contract D</option>
<option value="Free 30 Day Trial (New Advertisers OnLy)">Free 30 Day Trial (New Advertisers OnLy)</option>
</select><br>
<a href="http://www.powermarketers.com/jobrates.htm">Ad Rates/Specifications</a></font></td>
</tr>
<tr>
<td valign="middle" width="150"><font size="2" face="Arial">Contract Term:</font></td>
<td width="318"><font size="2" face="Arial">
<select name="ContractTerm" size="1">
<option selected>Select One:</option>
<option value="One Month">One Month</option>
<option value="Three Months">Three Months</option>
<option value="Six Months">Six Months</option>
<option value="Other">Other</option>
</select></font></td>
</tr>
<tr>
<td width="150" height="25" valign="middle">
<font size="2" face="Arial">Promotion Start Date:</font></td>
<td width="318"><font size="2" face="Arial"><input type="text" size="30" name="r. Start Date"></font></td>
</tr>
<tr>
<td valign="middle" width="150" height="25">
<font size="2" face="Arial">Ad Delivery Method:</font></td>
<td width="318"><font face="Arial" size="2">
<input type="radio" name="s. Delivery" value="E-Mail" checked><a href="mailto:[email protected]">Email Attachment</a></font><p>
<font face="Arial" size="2"><input
type="radio" name="s. Delivery" value="FTP/HTTP">FTP/HTTP Location<br>
<input type="text" size="30" name="t. Delivery URL"></font></td>
</tr>
<tr>
<td valign="middle" width="468" colspan="2">
<font size="2" face="Arial">Insert Ad Copy In This Box:</font></td>
</tr>
<tr>
<td valign="middle" width="468" colspan="2"><font size="2"><textarea name="Comments_Box"
rows="6" cols="50" wrap="physical"></textarea></font></td>
</tr>
<tr>
<td colspan="2" height="25" valign="middle" width="480"><font size="2"><input
type="checkbox" name="Contact me concerning other opportunities" value="Yes"><font face="Arial">Please
contact me concerning other advertising opportunities. </font> </font></td>
</tr>
</table><p><font face="Arial"><b><font color="#0000FF">Attention Advertisers:</font></b> </font></p>
<ul>
<li><font face="Arial">After clicking the "Submit Information"
button below, please allow up to 60 seconds for your information to be
processed. </font></li>
<li><font face="Arial">A confirmation page will appear in your browser once
your order has been received. </font></li>
<li><font face="Arial">Orders for immediate posting will be posted within 24
hours of receipt.</font></li>
</ul>
<p><input type="submit" value="Submit Information"> <input
type="reset" value="Reset Information"> </p>
</font>
<p> </p>
</form>
</td>
<td width="497"> </td>
</tr>
</table>
</font>
</body>
</html>