Advertising Request Form

Thank you for your interest in advertising on USHealthNet.com. Advertising can be placed on virtually any page on this Web site.
We look forward to working with you to meet your specific product or service marketing needs.

Please complete and submit this form, and we will be in touch with you regarding rates and placements at our earliest convenience.
If multiple companies want to sponsor under a specific product in our Health Product Finder section, they will be listed in
alphabetical order (with numeric company names, such as 3M, listed first). For an additional fee, advertisers also have the option
of becoming a "Featured Sponsor" or placing a banner ad in the Health Product Finder area.

All advertising and sponsorship is subject to approval of our Advisory Board. Please read our Advertising Policy. Thank you.

Fields marked with a are required.

Are you interested in sponsoring a banner ad? Yes No If so, where? Home page In the Product Finder area under a specific Product(s) Both Other page - Specify URL:
Are you interested in having your company listed and linked under a specific product in the Product Finder? Yes No
If yes, please list the product line items (e.g., Adhesive bandages) you want to be listed under, and to what product page on your corporate Web site do you want to point the link to? Product Line Your URL Point to: Point to: Point to: Point to: Point to: Note: If you want to sponsor more than five links, please submit multiple forms. Thank you.
First name
Last name
Title
Company
Product you represent
Address
City
State
Zip
Telephone
Cell Phone
E-Mail
Administrative Assistant contact information
By submitting this form, you confirm that you are in agreement with the provisions of the Terms of Use and Privacy Statement.