Please note: We reserve the right to submit all Fraudulent Orders and those orders that result in chargebacks without first trying to resolve the issue through our offices, to an industry related blacklist database accessed by over 200 advertising providers. The information stored within this database is a type of credit rating system that warns other networks of negative actions. If your company appears in this database, you may have trouble purchasing any further advertising products for your business.


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1. Your E-mail *
2. Your Name *
3. Your Phone Number * Must be your correct phone number to avoid your order from being cancelled. This is to verify your order. Due to fraudulent orders, we will verify every order by phone if it looks fraudulent
4. Website address to advertise *
5. Login information to your home business back office or Autoresponder such as Aweber or Getresponse To know which signups have come in from our advertising efforts. To not provide access, please put No login info
6. How did you find us?............ * Clicked on banner ad (please specify where in your comments)   
Ads by iTotalFind   
Yahoo   
Email Advertisement   
Bing   
Ordered from Search Engine Ad: http://www.trafficexcess.com/Traffic.html   
Referred by Gerard School or Studio2000   
Referred by Julian Angel - Bellamoon Accessories   
Referred by Christopher Plant   
Contacted by a Sales Associate   
Referred by John ORyan - TrafficMan.us   
Clicked on Creative Ad: http://www.trafficexcess.com/temail.html   
Google   
Recommended by a Friend   
I have ordered advertising from Traffic Excess before   
If Other, please tell us where you found TrafficExcess.com in your comments   
7. Enter the City where you are currently placing the order from * To prevent fraudulent orders, we verify the city your order was placed in with the credit card company's database
8. Enter the State where you are currently placing the order from * To prevent fraudulent orders, we verify the city your order was placed in with the credit card company's database
9. Comments or coupon code