Home Up

Order Form
 •  •

ORDER FORM

How to list your company

Follow these two steps:

1.  Fill out the Basic Listing Information for your FREE listing.

2.  For a Premium Listing - add the additional zip codes (up to 20) and corresponding cities.

3.  For a Spotlight Listing - Fill out the additional information at the bottom for your webpage design.

4.  Complete the Payment Information at the bottom and click on SUBMIT to send directly to CleanRx.com.

Please feel free to call or email with any questions!

Sales@CleanRX.com

Voice:  800-829-7014, Fax 440-845-1940

(Note:  Your privacy will be protected.  We will not rent, trade, sell or give away your names and addresses.  You may receive an occasional E-mail only from us when we feel we have some important information that you might be interested in.)

FREE BASIC LISTING INFORMATION

  

     

  

  (if you have one already)

Services Provided (please click on box to put a check in it for all services you provide):

 

 

 

 

 

 

FOR PREMIUM LISTINGS ($17 Monthly Hosting):

How Did You Hear About Us?

           

BASIC AND PREMIUM LISTINGS ONLY - STOP HERE AND SCROLL DOWN TO THE PAYMENT INFORMATION

 

SPOTLIGHT CLEANER - Web Page ($27 Monthly Hosting and Maintenance, Plus $50 one time design charge) Includes all of the above

Complete the Basic and Premium Listing information above.  Next describe your company, services, on-time policies, guarantees, etc.  Below are some suggested topics, but feel free to be creative.  Send logos and pictures via US Mail or E-mail separately to sales@cleanrx.com.

Pick your unique web address.  Most use their company name. 

PAYMENT INFORMATION

- $17/Month (credit card required)

- $27/Month plus one-time $50 design fee (credit card required)

 

 

Please call to safely give us your Credit Card information, 800-829-7014.

                

 

CLICK ON THE SUBMIT BUTTON TO HAVE YOUR INFORMATION EMAILED DIRECTLY TO CLEANRX.COM.

Thank you!  We will be in touch soon to confirm your information!

___________________________________________________________________________

CleanRX.com - Contact Information

Telephone - 800-829-7014        FAX - 440-845-1940
Postal address - 6674 Pearl Road, Parma Hts., OH  44130
Electronic mail - General Information:  Click here - Sales:  Click here
Last modified: 04/18/08