ICCS WEB SITE Certification Application

P.I.N.	Product and Service Review Submission Form

SECTION #1


Company / Organization
Company Type

Indicate Product Type:	( if applicable )
Indicate Service Type:	( if applicable )
Product Title


YOUR URL
Contact E-Mail Address

Web Site Type
Primary Connection
Category
Language
SECTION #2 If you are NOT submitting your product for ICCS Certification, skip this section and go to Section #3 ICCS™ CERTIFICATION FEE - $1495 Per Year Certification Type: New Certification Renewal of a Previous Certification Please submit a check made payable to Positive Image News in the amount of $1495 for a licensing period of one year from the first day of the month following the date of your payment. If your application is submitted during a trade show event we are covering, you can pay a PIN staff member directly or send your check to: Positive Image News 395 East Surfside Drive Port Hueneme, CA 93041-3343 If you have any questions, please send an email to info@positiveimagenews.com SECTION #3 *Tell us about your product or service...* Note: Be sure to press the Enter key at the end of each line in the Comments Section, so we don't lose anything. Comments: