Bucksville Oaks Form

This is the form where the user will complete the information about themnselves and the ad detail.

Company Listing - BASIC AD ($XXX/month)
Visible in Ad?
Contact Name:*
Company Name:*
Address (street):*
City, State, ZIP:*
Primary Phone:*
Email Address:**
Website Address:*
* Denotes Required Field
Categorization of Company Services (< 25 characters):*

BRIEF Description of Company Services (< 55 characters):*

More Detailed Description of the Company Services (< 500 characters):*


YOU HAVE COMPLETED THE REQUIRED
INFORMATION FOR THE "BASIC LISTING"
Please review all of the above information before proceeding.
Your listing will be viewable under the specific region, city, and state. To proceed
with placing this listing, please complete the following and proceed to Payment.
The cost for this Basic Listing will be $XXXX per month.
Information for Security Purposes
Security Email:*
Security Question:*
Security Answer:*
* Denotes Required Field
PROCEED TO CHECKOUT FOR THE
BASIC LISTING AT $XXXXX PER MONTH.
Housing for Travel Nurses reserves the right in its sole discretion to improve, modify or remove any information or content appearing on the Website. To assure the value of Housing for Travel Nurses services, you agree that all of the information you have provided to Housing for Travel Nurses, whether online or otherwise, is accurate and complete. Lessors shall be responsible for preparing and submitting the Property advertisements, and shall be solely liable for assuring that such advertisements are accurate, and comply with all applicable laws. After your ad is reviewed and edited for grammatical and formatting errors, it will become active within 48 hours. If there are any issues regarding your ad, you will be contacted.

If you have any questions or concerns with you add, feel free to Contact Us. To cancel your current listing, please use the Cancel Your Listing form.
I read the attached "Terms and Conditions" and fully agree: