Suppliers Directory Registration Form

Price is just $95 for first category, $10 each additional
Fill in the form, then click submit button on bottom of page. We'll email you confirmation and an invoice.
Listings are valid for 12 months, starting in May.
Questions? Contact directory@wireropenews.com, 732-602-4006.
Name*
Personal email*

(Note: We need this to contact you. This email will NOT appear in The Suppliers Directory.)
Company*
Link all my chosen categories to my company’s website for $100 extra.*
- Yes
- No
(Your web address will be highlighted, and when a potential customer clicks it, they will go directly to your website.)
Do you want to be contacted about display advertising? List under 10 categories FREE with a display ad. ($185 Value!). Ask for details: directory@wireropenews.com • 732-602-4006.*
- Yes
- No
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Company Contact (26 maximum character count)
Phone
Fax
Email address
Website address
CHOOSE FROM THE FOLLOWING PRODUCT/SERVICE CATEGORIES
Optional: You can add a short, descriptive subhead on right – 35 characters max. including spaces. Must choose at least one category or the form will not register.
Category*
Subhead

35 maximum character count.
CAPTCHA

CHOOSE FROM THE FOLLOWING PRODUCT/SERVICE CATEGORIES