First name Last name

Business name

Address City

St Zip E-mail *Important

Phone # Phone # Fax #

Web site address (if applicable) You may add your website at any time - no additional cost

1 year membership $50.00 ------------ 2 year membership $80.00

Multiple locations (ie. states) or directory listings (ie. technician, educator, supplier) - additional $25.00 per year or $20.00 ea/ 2 yr.

(Please indicate locations)

Method of Payment Visa Mastercard Discover ** Please call 888-608-9828 to register or renew your listing by credit card. We are unable to process credit cards online at this time. Thank you.

Check (Allow one week to post listing)

MAKE CHECK PAYABLE AND MAIL TO: Kevin or Michele Petit, PC NETWORK - 551 Miles Oak Lane - Nipomo CA 93444

YOU MAY ALSO PRINT AND MAIL THIS FORM OR YOUR OWN TYPED INFORMATION TO THE ABOVE ADDRESS FOR YOUR DIRECTORY LISTING OR FAX YOUR INFORMATION TO : Fax (240) 255-7745

Use the space below to write your business listing. (Go HERE to look at other peoples listings for ideas)