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Name: _________________________
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Email: _________________________
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Company (optional): ______________
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Address: ______________________
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City: __________________________
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State: __________
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Country: ____________
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Zip: _________
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Phone: (___) ____- ______
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( ) I am enclosing a check or money order for $47.00. Please note that we do not accept checks by fax, so if you are paying by check you must mail it in to the address above.
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( ) I want to charge this purchase to my Credit Card
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I authorize The Internet Marketing Center to charge $47 to my credit card for the
purchase of the Bulletin Board Blaster software