Pay By Mail Order Form
|
ASU
Service
PO Box 452
Meridian, Idaho
83642
208-890-4447
ALL FIELDS ARE REQUIRED!
| Customer Info | |
| Name: | |
| E-Mail: | |
|---|---|
| Company: | |
| Mailing Address: | |
| City, State, Zip: | , |
| Phone: | |
| Item Ordered: | |
| Comments or Questions: If ordering multiple items choose first item from dropdown list then list additional items here. |
|
| Payment Type | Credit Card Check Money Order |
| Credit Card Info | |
| Type of Credit Card: | |
| Credit Card Number: | |
| Expiration Date: | (MM/YYYY) |
| Billing: (IF different than Customer Info) | This Info MUST match the Billing Info of the Credit Card |
| Billing Name: | |
| Billing Address: | |
| Billing City, State, Zip: | , |
| Banner Info | |
| Banner URL: | |
| Billing Address: | |
| Sponsor Ad Info | |
| Enter the text of your ad: Limited to: 6 Lines x 60 Characters incl. Spaces |
|
| Solo Ad Info | |
| Enter the text of your ad: Limited to: 30 Lines x 60 Characters incl. Spaces |
|
| Total Amount: |
Print this form and Mail it to:
ASU
Service
PO Box 452
Meridian, Idaho
83642
208-890-4447
All Material is Copyright 2000 of ASU Service.
All images are copyright and/or licensed by ASU Service and may not be
displayed, altered or utilized in any way by anyone other than ASU Service.
License release on file at ASU Service Company Headquarters Meridian, Idaho.
EMail ASU Service with any questions regarding image usage.
All rights reserved.