Your personal name:
  
Trading as name:
  
Address:
  
Town:
  
City:
  
Post Code:
  
Telephone:
  
web address:

Public E-mail (the one every one can contact you with):
  
Which listing do you want the banner to appear under:

Paying by card, enter type, Visa, Master, etc:

Issue Number SWITCH ONLY:

Card Number:
  
Card Security Code, last three digits in signature strip: 

Starts:
  (mm/yy)
and Expires:
  
Amount £10 for one year or £20 for three years £
  
Price includes maintenance and updating as you require.

We will debit your card once the banner has been uploaded.
Please attatch the banner to this message.
Banner size is 468x60 or 400x80
This is for the first year or three years as specified.

Email this form to
graham@weddings-in-wales.co.uk

You can pay by card over the phone 01792 229191
Tuesdays to Fridays 9.30am till 1.00pm

Or post with your cheque payable to Galaxy Studios
The Weddings in Wales Website
Galaxy Studios
3 Bryn Terrace
Gorseinon
Swansea
SA4 4DE