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IF PAYING BY PERSONAL OR BUSINESS CHECK OR MONEY ORDER PLEASE PRINT
(2) COPIES OF THIS FORM,ONE FOR YOUR RECORDS and ONE FOR OURS RECORDS.
FILL IN YOUR SELECTIONS AND THE INFORMATION BELOW, SIGN AND RETURN OUR COPY WITH
YOUR PAYMENT OR IF USING PAYPAL YOU CAN FAX THE FORM TO US: (Service begins when you check has cleared our bank. Allow 7 to 10 business days.) NAME______________________________________________________ BILLING ADDRESS____________________________________________ CITY/TOWN_________________________________________________ STATE AND ZIP CODE____________________________ __________ TELEPHONE # WITH AREA CODE_______________________________ EMAIL(optional)_____________________________________________ SIGN__________________________________________________ DATE______________ Mail your check/money order and sign-up form to: 7765 Stand Circle #101 Mechanicsville, Va. 23111 |
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