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Order Online

Thank you for your interest in joining Nursing Home INFO. Ordering an upgrade to your listing online is easy. Please complete the following form. You will be billed for the service. An invoice will be faxed or mailed to you. If you would prefer to order by telephone or have problems ordering online, please call us Toll Free at 800-536-2657.

 

Your First Name
Your Last Name
Your E-mail Address
Relationship to Facility
If Other, Please Describe
Facility Name
Facility Address 1
Facility Address 2 (Optional)
Facility City
Facility State
Facility Zip Code -
Facility Telephone Number - - Ext.
Facility Fax Number - -
Facility E-mail
Facility Web Site Address
   
Please provide the following billing information if different from above.
Billing Contact First Name
Billing Contact Last Name
Billing Address 1
Billing Address 2 (Optional)
Billing City
Billing State
Billing Zip Code -
Billing Phone (Daytime) - - Ext.
Billing Fax - -

Select Advertising Package
Premium Package $249 per year  
Web Link Package $129 per year  
Expanded Listing $49 per year  
Facility Web Profile (1-page) $300 per year  
Facility Web Site (5-page) $500 per year  
 
I am interested in occasionally receiving information about other products and services that may benefit my facility.
 
By placing this order I agree that I am acting as an agent of the operator of the above described facility and may authorize this order. Assisted Living INFO is a subscription service that is performed for the operator of the facility and the service transfers to any new owner of the facility's operation. The facility is billed annually for continuation of the subscription. If the facility elects to cancel the subscription, it may terminate in writing within 15 days after the date of the annual billing. After that date the annual fee becomes due and payable. If the facility closes or elects to terminate the subscription within the term of this agreement, they may do so by notifying us in writing. The annual subscription fee or any unused portion is non-refundable.
 

 

   

Nursing Home INFO
N47213 Ellenberger Lane
Eleva, WI 54738
(800) 536-2657
FAX (715) 287-4728
E-mail: NHINFO@NWLTD.COM

 
Nursing Home INFO and Assisted Living INFO are services of Nelson & Wallery, Ltd.
Copyright © 2003 Nelson & Wallery, Ltd. All Rights Reserved.