Clarence Home LLC, PO Box 536, Clarence, NY 14031 Tel: 1-877-414-8087 Fax: 1-520-441-4054

Client Information

The information requested below will allow us to launch an informative Internet presence for you.

Please fill out this form, save it as “your_name.dot,” print it out, and mail to Clarence Home LLC, 5225 Goodrich Road, Clarence, NY 14031 with your user agreement and check or money order. As a preferred option, email the completed version back to , with your business name in the subject heading.

Use the TAB key to advance through the fields:

Plan Desired:Standard Gold

Company Name:

Nature of business:

Contact Name:

Contact Title:

Address:

City, State, ZIP:

Email address:

Tel Number:

Cell Number:

Fax Number:

Best time to call:

In business since:

What is your main purpose for advertising on Clarence Home?

Directions to your location(s). Include any landmarks that may help a first time visitor.

What do you wish to call your home web address (yoursite), using the format It is suggested that this be kept short but descriptive (i.e.

If you have an email address you wish listed at Clarence Home please note it here (call Juno at 1 (800) TRY-JUNO or visit them on the web at if you would like free email):

If you have web sites you would like listed at Clarence Home note them here (up to 5):

Gold Plan Only: If you have any images you wish to include on your site please note them here and include in mailing or email (as attachment):

What is your preferred heading (i.e. Auto Repair, Restaurants, Video Rental, etc.)?

Please describe your business in a form that would attract clientele. Include services and or products your organization provides, and any unique characteristics. Use several descriptive sentences. This will be included on your home page:

What would make a potential customer choose you over others?

What “keywords” (up to 10) would you use to describe the uniqueness of your business (i.e. wicker baskets, Lindt chocolate, Barbie dolls, 78-RPM records, etc.)?

What keywords (up to 5) would you use to describe the common elements of your business (i.e. pizza, take-out, restaurant)?

What are your hours of operation?

What type of customer are you looking for?

Gold Plan Only: If you are a restaurant, would you like your menu listed? YES NO

If you do, can you mail (diskette) or email (file) if available? YES NO

If not, send a version that can be scanned:

Version for scanning to be sent: YES NO

Gold Plan Only: If you have any special items to be scanned, please note here and mail with instructions.

What do you like about Clarence and your customers (optional)?

Favorite web site (optional):

Do you have products you wish to sell over the Internet? YES NO

Would you be interested in setting up the capability to sell via the Internet? YES NO

If you have special requests or instructions, please note here.

A draft version of your web site will be created soon after Clarence Home LLC receives this form along with your check or money order. Your web site will then be mailed (conventional or email) to you for your review, correction, and approval. Once it is returned to us, it will be updated and uploaded to ClarenceHome.com for the world to view!

For those who are not quite ready to advertise with Clarence Home LLC, you can still have your name, address, phone number and fax number listed for free in the ClarenceHome.com directory. All you have to do is agree to post the decal on your main entrance door. If you could, please note your reason for not joining us:

I am not interested in advertising with Clarence Home LLC now, but I would like to take advantage of your free listing offer, and I agree to post the label* on my entrance door.

Initial:

* A decal will be mailed to you soon after this form is received. The label should be placed on the inside of your entry door. Clean the glass surface, peel off the backing (one corner has the backing creased), and place on door at eye level. Thank you!

1