Your personal name: Trading as name: Address: Town: City: Post Code: Telephone: Public E-mail (the one every one can contact you with): Which listing do you want the banner to appear under: Paying by card, enter type, Visa, Master, etc: Issue Number SWITCH ONLY: Card Number: Card Security Code, last three digits in signature strip: Starts: (mm/yy) and Expires: Amount 10 for one year or 20 for three years Price includes maintenance and updating as you require. We will debit your card once the banner has been uploaded. Please attatch the banner to this message. Banner size is 468x60 or 400x80 This is for the first year or three years as specified. Email this form to You can pay by card over the phone 01792 229191 Tuesdays to Fridays 9.30am till 1.00pm Or post with your cheque payable to Galaxy Studios The Weddings in Wales Website Galaxy Studios 78 High Street Gorseinon Swansea SA4 4BL