Advertiser's e-mail address:

Advertiser INFORMATION:

First Name:

Last Name:

Company Name (if applicable):

Web Site URL:   (example: www.yoursite.com)

Contact Phone Number: Day Evening

Mailing Address: (Street, Suite/Apt.)

City and State:

Postal Code: (If you live in a country without a Postal Code Enter "None") Country: (If other than U.S.A.)

What type of Service(s) or Good(s) do you offer?

What is your ad text? Maximum 100 words.

E-mail your artwork and/or or logo to: esupport @MyPoupette.com. Size restrictions apply. Maximum dimensions are 210W x 75H in pixels. We also need an ad that is 275 x 75 pixels.

Are you planning to link primarily to eBay?   No    Yes

If "No", please provide the link to your site:

Do you own this site? No    Yes

Advertisements will appear on these three links:

http://www.mypoupette.com/mprs.php
 (busiest link)

http://www.mypoupette.com/confirm.html
 (second busiest link)

 http://www.mypoupette.com/faves.php
 (accessible from the link at the bottom of each page)

If you also wish to have your ad appear on other pages or on other My Poupette Sites, please contact us for rates.

To qualify for adveritising on My Poupette, your site must: Not offer or link to any sites that sell replica designer products that claim to be authentic ; Not be an unsuitable site ; Offer reasonable value for your charges Settle all disputes quickly and amicably Operate in a professional, ethical and courteous manner. We reserve the right to not accept or to discontinue your ad at any time if, in our sole discretion, we determine that you have become unsuitable to advertise. If this occurs, your prepaid funds will be returned to you, less a $75 administrative fee applied to the total amount paid. Not have "no-escape" ads. Sell only money-back guaranteed authentic merchandise protected by security seals. We have these available for sale.

You must provide additional information such as photos, receipts, or identification, upon request, within 5 business days.

Submitting this form indicates that you have read and agree to abide by the above terms and conditions.

Questions: esupport @mypoupette.com (remove spaces)

All information submitted will be held in the strictest of confidence. Payment will be due on the next page, if not already paid.