Devine Business Listing Request

Current cost for a business listing on www.devinetx.com is $15 per month, billed quarterly or annually. Those paying for one year in advance will receive 12 months for the price of 11 ($165).

Billing Information:
Business Name:
Billing Address:
City: State:
Zip Code:

Contact Information:
Contact Person:
Position Within Company:
Contact Phone (Day):
Contact Email:

Listing Information (include only what you want displayed in your listing on devinetx.com):
Business Name to be listed:
Website Address (URL) if applicable
(http://www:
Business Physical Location:
Business Telephone Number:
Business Fax Number:
Business Email Address:

Brief Description of Products/Services:

I prefer to be billed:
Quarterly ($45 every three months)
Annually ($165 annuallly, get one month free!)

I would like information on having a custom website designed for my business that will be linked to my business listing.

I would like information on having a one-page ad designed for my business that will be linked to my business listing.