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Canada Nightlife Guide : Escort Agency Sign-up form  
 

Escort Agency Sign-up Form

Please fill out the following form to sign-up for Escort Agency advertising on the CanadaAtNight.com web site. Provide as much detail as possible, as your potential clients are looking to find out as much detail about you. The more information and pictures that you provide, the more calls and inquiries you will get.

Personal Information
Name:
Email:


Web Site:


Address


Phone:
Fax:
City:
  This information will be shown in the advertising. Please fill in all the required fields.
     
Business Profile
Business
Description:
Escort #1:
(Photo & Description)

Escort #2:
(Photo & Description)

Escort #3:
(Photo & Description)

Escort #4:
(Photo & Description)

Escort #5:
(Photo & Description)

Escort #6:
(Photo & Description)

 

Please take your time in this area. The more information you provide here, the more successful your ad will be.
     


Sales Associate ID:

 
Advertising Packages
Choose an advertising package (prices include GST):  

The only difference with standard and premium is that your ad will be place above the standard A-Z listings.

Automatically renew my account on a monthly basis

6 Month Standard Directory Listing ($265.00) - 1 month free

12 Month Standard Directory Listing ($530.00) - 2 months free

6 Month Premium Directory Listing ($397.50) - 1 month free

12 Month Premium Directory Listing ($795.00) - 2 months free

  
 
Payment Information * All of the following is required to process your order
How would you like to pay for your ad? Note that your ad will not be posted until payment is received.
Visa   Mastercard   Paypal    Cheque/Money Order    Western Union   
if you would rather call us with your payment information, dial 1-866-729-9653
 
If you are paying by credit card, fill out the following information:
Credit Card #

Name on Credit Card:

Billing Address

Expiry Date:

CVV2 Code:
(The last 3 or four numbers on the back of your card)
 
Form Security
* You must enter the correct code for the form to be submitted.
Code:
Canada Adult Advertising
 
   
 
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