Please complete this form

Please complete this form, print it, and send it with an enclosed cheque for the correct amount to:-

S Cassie

Galloway Classifieds

Aird Donald Caravan Park

London Road

Stranraer

DG9 8RN

Please make all cheques out to Casstek.

Please use this form to open account and place your first advert with us. THIS IS FOR BUSINESS USERS ONLY.
If you just want us to create the account and credit it with the desired advert for use later, please leave section 4 blank.

Please provide the following contact information:

First Name
Last Name
Title
Business Name
Street Address
Address (cont.)
City
County
Postal Code
Work Phone
FAX
E-mail This is used for the Advert email contact
If you have a Business Website, provide its address. Your advert will contain a link to it.
Type of Business

Enter your Desired Username in the space provided below. ( this will be used as your login name on the website if you need to login )
No spaces in the username please, up to 10 characters.
If your already an existing user, please input " EXISTING USER" in the password box and your existing account will be credited with the required advert.
Choose one of the following options.Other options are available if you choose to use our online payment system:
If you would like us to place your advert for you, please type the text in the box below, and please include any contact information your advert is to contain. ( you can log in and edit the advert at any time using the username in section 2 )

If you want to login to your account please use the username you provided us and request your password using the Websites password retrieval function. The password will be Emailed to the address provided in section 1.

Please keep a copy of this form for your own records.