PAYMENT INFORMATION
__ Cash (in-person transactions only, please)
__ Check #______________________
__ Credit Card (circle one): MC/V/AX/DISC/DC
Your name
as it appears on Card:
_____________________________________
SHIPPING ADDRESS
Name ________________________________
Address
______________________________
City/State/ZIP
__________________________
Phone
________________________________
Alt.
Phone
____________________________
Email_________________________________ |
Credit
card # __________________________
Exp.
date: ________/_________ CID: _______
Cardholder
signature:
_____________________________________
Name ________________________________
Address
______________________________
City/State/ZIP
__________________________
Phone
____________________________________
_____ Yes! - I would like to hear about great new
products, services, and classes as they become available.
|
