Return to Side-by-Side Comparison page
Membership Enrollment Form
Enhanced Directory Listing ~ Just $37.50/year
(This information to be held in strict confidence and will not be shared with any other party)
All pages beyond here are encrypted for security
Filter Type:
Email:
    Enter your email address above to activate our auto responder
Company Name:
Street
Unit:
City:
Zip Code:
P.O. Box:
City:
Zip Code:
Business Category: Choose Primary & up to 3 Other Categories
(Not All Choices Guaranteed To Be Listed But By Submitting, We Will Be Able To Better Determine Best Placement)
1.)
2.)
3.)
4.)
Located within a major commerce center:
(if other, please list)
First:
Last:
Title:
Contact Name (If Different)
Phone:    
Toll Free:
Fax Line: 
Cell Ph:   
Home:     
Web Site:             
Alt Page:              
Email Address:     
GPS Coordinates:
Receive Monthly Newsletter: Yes  No
A Motto, Slogan or Two-Line Descriptive Verse About Your Company
Display Content Information
Contact Name Yes  No
Street Address Yes  No
       Telephone Yes  No
         Toll Free Yes  No
         Fax Line Yes  No
      Cell Phone Yes  No
  Home Phone Yes  No
              Email Yes  No
Charitable Contribution: Please select the organization you want us to support.    (more information)
 Barium Springs Home for Children  Children’s Miracle Network  Make-A-Wish Foundation  Shriners Hospitals for Children  St. Jude Children's Research Hospital  Hospice of Burke Co  Hope House Foundation  Divide Equally  Other:
If "Other," Please Submit Your Request:
Charitable Contribution:
We will donate 40% of your membership fee & renewal fees to the charitable organization selected above. An additional percentage will be used to advertise and promote this website.

Your membership is guaranteed renewable for life at this low rate as long as there is no lapse in service.

Love Burke Living

Professional Custom Web Site Design & Ecommerce
Custom Web Site Design & Ecommerce