Membership or Classifieds Order Form:

To print the order form, simply click on the printer icon above.  (The document will open in another screen in .pdf format).  The form may also be used to order an ad.  Applications can also be requested by calling (570) 297-0455 or by email to This e-mail address is being protected from spambots. You need JavaScript enabled to view it .

Receive three free months of membership and full benefits with no obligation.  Send no money now.  Feel free to scan and email the completed membership application to us at This e-mail address is being protected from spambots. You need JavaScript enabled to view it  or fax it toll free to 1-888-266-4923.

Tell us about your organization:

Company Name: ________________________________________________________

Contact Person: _________________________________________________________

Street Address: _________________________________________________________

City, State and Zip: ______________________________________________________

Phone: ______________________________ Fax: _____________________________

Email: ___________________________________

Website Address: _____________________________________

Online Store(s) Website Address:  ________________________________

Blog address:  __________________________  Facebook: _____________________

Twitter:  _________________________  Other Social Media Page:  ________________

 Enter a description of your organization and services or products offered:

____________________________________________________________________

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____________________________________________________________________

____________________________________________________________________

____________________________________________________________________

Enter your advertisement text here, up to 75 words:

____________________________________________________________________

____________________________________________________________________

____________________________________________________________________

____________________________________________________________________

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To which category would you like to have the ad posted?  (Circle one)

"Services" --  "Items For Sale" -- "Vehicles"  -- "Employment"  -- "Real Estate" 

Authorized Signature:  __________________________________________

Note:  Checks are payable to Twin Tiers Media Solutions and mail to 509-3 Canton Street, Troy, PA  16947.  Our email address is This e-mail address is being protected from spambots. You need JavaScript enabled to view it .  Phone:  (570) 297-0455    

 __ Check here to receive free information about promoting your business on our partner sites, www.wellsboromall.com and www.mansfieldmall.com.

2010-2011 Renewal Options

Introductory Membership for new members:  First three months free!  Join us after 3 months for just $38 to receive a full year.  Upon your one year membership anniversary date, renewal options are listed below according to your business structure. 

                                                          Semi-Annual                     Annual

Nonprofit:                                              $50                                 $85

Sole Proprietorship:                            $80                                 $135

Corporate/Co-op:                                 $125                               $215

If membership is paid in full one month before 12 month anniversary date, deduct 10% discount!

Note:  Inability to pay does not preclude your membership possibility.  If you are encountering hardship, write and let us know at This e-mail address is being protected from spambots. You need JavaScript enabled to view it for possible membership fee reduction.