LEADZ form

Thank you for your interest in South Florida Aliiance by LEADZ.com
Please use this form to place you order.

Get listed
Basic South Florida Listing	$250
Advanced South Florida Listing	$950
Main Category:
Additional Categories:
South Florida Link Exchange
1 year Participation	$240/year

To Order by Telephone call 954-315-0248

Listing Information

Business Name:

Contact Name:

Address:

City:

State:

Zip:

Telephone:

Email Address:

Website URL:

Power Code

Referral Code

Credit Card Information
(All Fields Must be filled in)

All orders are submitted through a secure, encrypted server for your protection.

Select Card:

Visa MasterCard American Express

Card Number:

Expiration Date:

Month (ex: 04) Year (ex: 00)

Name on Card:

Zipcode:

By submitting this order, I agree to pay LEADZ.com the amount for the listing/sponsorship that I have chosen above.

Checks should be made payable to:
Preferred LEADZ, Inc.
1456 SW 13th Court
Pompano Beach, Florida 33069

To pay by telephone, call:
(954) 946-6266