Affiliate's Business Name:____________________________________________________________________________________________
Contact Person:_____________________________________________________________________________________________________
Contact Address:____________________________________________________________________________________________________
City:_____________________________________________________________ State:____________________________ Zip:___________________________
Phone:_________________________________________________________ Fax:_____________________________________________________________
E-mail Address:_____________________________________________________________________________________________________________________
Ad Copy Attached?__________________________________________________________________________________________________________________
Special Instructions?_________________________________________________________________________________________________________________
_____________________________________________________________________________________________________________________________________
You may choose up to Six Selections to be Linked to within The Totally Wholistic Online Directory.
(this does not include a link outside of The Totally Wholistic Directory)
1)______________________________________________ 2)_______________________________________________________
3)______________________________________________ 4)_______________________________________________________
5)______________________________________________ 6)_______________________________________________________
The Totally Wholistic Set-Up Procedure Application Form
*Please write a maximum of 300 words describing yourself and what you do. For all those that are paid in full we have a professional writer on staff who can help. There is a limit of up to 1 hour of time including intake information, drafting, and final copy, all free of charge.
* Free set-up of a customized posting of your services(s) and/or product(s) by own art department. Or you can submit an idea of your own. Remember that all pages have Totally Wholistic framing around each page.
*Small changes such as changing a phone number, or adding an extra short paragraph from time to time is free. Keep in mind, that there is a 300 word limit on all web pages.
*All listings for the Community Happening Calendar must be submitted no later than the 15th of the prior month. That is all submissions must be received by April 15th for May 1st . All submissions must include 2-3 sentences about your event, date, time and contact information.
*You are strongly are encouraged to use your web page on all your advertising. Remember, this is your personal mini-web site!
*Your page on Totally Wholistic can be directly linked to anther site, or even to an e-mail address. We lay no claims that we can guarantee it being problem free. We must have in writing that it is okay to link to this site and we will need the exact web page address. Totally Wholistic will not link to any objectionable site(s) or address(es). If this is the case, Totally Wholistic will disconnect the link at once and no refunds will be made.
*There is a 50% non-refundable policy within the first week. After the first week there are no refunds. Membership is due and payable at the time of the signing of this agreement between the advertising member and Totally Wholistic, unless other prior arrangements have been made.
*This completed and a signed setup procedure page must be returned.
*You may be listed on as many as 6 sections of Totally Wholistic, providing that your information supports it. If you do not see a section that is in your area of expertise, please contact Dr. Beller and discuss the matter directly with her. All reasonable efforts will be made to accommodate your needs.
I have read and fully understood the above. I further agree to the terms and conditions of the Totally Wholistic set-up procedure. I also certify that all the information given is accurate and up to date.
___________________________________________________________________________________________________________
Sign and Date
Print Name:_________________________________________________________________________________________________
Method of Payment:__________________________________________________________________________________________
For all those that wish to Pay Via Pay Pal or Credit Card we will need an E-Mail Address in order to send you an electronic invoice.
Please mail back an original copy of this form completed and signed along with your payment or e-mail address.
To: Totally Wholistic, Box 1454 / Main Rd, Southold, NY 11971
Make payable to Totally Wholistic
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