Application for Listing
For the following Cities, we are offering a FREE trial listing!

Nanaimo, Duncan, Courtenay, Comox, Parksville, Campbell River,
Ladysmith, Ucluelet, Gulf Islands

Business Name: _______________________________________________

Contact Name: ________________________________________________

Phone Number: ________________________________________________

Email Address: ________________________________________________

Website Address: ______________________________________________

City I want a listing on: _________________________________________

Other Cities: LISTING OPTIONS:

____ Sooke.org $100.00

____ Metchosin.org $25 extra when you advertise on Sooke.Org

____ Sidneybc.org $25 extra when you advertise on Sooke.Org

TOTAL PAYMENT: ________

Mail to: PAX MEDIA INC.
3001 Manzer Road Sooke, BC V9Z 0C9
tel. 250.642.6745 fax. 250.642.7722
www.paxmedia.ca

Request rec'd by: ________ Date: _________________
Please print out the form and either MAIL it in or FAX it in
Phone: 1 250 642-6745 ~ FAX 1 250 642-7722