UNIFORMBOUND.COM
Mail And Fax Order Form
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MAILING INFORMATION:
Include your check or money order paying
for the term you wish to join, and mail to:
MaL Content Media 304 Main Avenue - Suite 250, Norwalk, CT 06851
Make all checks payable to: MaL Content Media, LLC
Fax and Money Order memberships will be active within 24 hours of receipt of payment
ALL Personal Checks must clear
the bank before your
membership will be activated, this may take up to 14 days.
FAXING INFORMATION:
Fax this completed form to the following number 203 - 849 - 1594
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YOUR FULL
NAME:____________________________________________________________
STREET ADDRESS:___________________________________________________________
CITY:______________________ STATE:_____________________ ZIP CODE:_____________
COUNTRY:___________________________________________________________________
PHONE NUMBER:_____________________________________________________________
E-MAIL ADDRESS (required):________________________________________________
TOTAL AMOUNT YOU OWE (In US Currency) $_________________________________
PLEASE CHOOSE THE TYPE OF MEMBERSHIP:
ALL ARE NON-RECURRING
One month = $13.95 - Two months = $24.95 - Three months = $37.95
CHOOSE A USER NAME:________________________________
(up to 8 letters/numbers)
CHOOSE A PASSWORD:________________________________
(up to 8 letters/numbers)
IF PAYING BY CREDITCARD : YOUR CREDIT CARD NUMBER::__________________________________
YOUR CREDIT CARD'S EXPIRATION
DATE:__________________
YOUR SIGNATURE: __________________________________________________________
Certifying you are an adult and over 18 years old.
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