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Highest
Summit Media PLEASE
PRINT THIS FORM OUT - YOU CANNOT USE IT ONLINE |
| Your Name: | ____________________________ |
| Phone Number: | ____________________________ |
| Email Address: | ____________________________ |
| Ship to: | |
| Name: | ____________________________________ |
| Address: | ____________________________________ |
| City, State Zip | ____________________________________ |
| Country | ____________________________________ |
| DESCRIPTION |
QTY
|
Unit Price
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Total
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| Million-Dollar Professional Service | $197.00 USD | ||
| Power Copywriting for the Internet | $157.00 USD | ||
| Direct Marketing Hotseat | $137.00 USD | ||
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Total Price: |
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( ) I am enclosing a check or money order Please note that we do not accept checks by fax, so if you are paying by check you must mail it in. Make money orders payable to Highest Summit Media.
Credit Card Type: ______________________ Card Number: _________________________ Expiry Date: _________ Address (as appears on credit card billing statement) Signature: _________________________ I authorize Highest
Summit Media to
charge my credit card. |