If you
prefer to use the mail, just fill in and print out this Mail Order Form. Set
the choice boxes with the right stuff before you print it out. Print only Page One of One.
Mail it to MetaSyn Media along with your check or
credit card authorization made out to: Michael Mandeville at 33801 South Old Mud Springs Road, Black Canyon City Arizona
USA 85324. NOTE: FOR
APRIL 2002, PAYMENT CAN ONLY BE MADE BY CHECK OR ONLINE THROUGH EBAY BILLPOINT OR PAYPAL.
I wantof the following items
How did you find out about this work? (select one from this menu)
If you want to make multiple orders of different items, you
can submit this form for each item separately and we will consolidate the order on our
end. Just fill this form out, print it, change the item selected, and then
print the form again. Or just write down a list, using the 15 numbers on the Order List,
how many of which items you want. Any applicable sales taxes and VAT taxes which must be
paid in your location will be added to the charges which are made on your credit/debit
card. Arizona residents add 7%. For all delivery of CD's and Tapes outside the
United States, we add $3 to ship each item, for books, $12.00 for each item. Within
the U.S., price includes postage anywhere and it is shipped within three days of receipt
of payment. Hint: You can use the
mouse to click into the blank area and you can use the tab key to move from blank to
blank.
BILL TO:
(Buyer's Name & Address) Please ship to this billing
address:
SHIP TO: (leave blank if
same ) Please ship to this address below
First Name
First Name
Last Name
Last Name
Your Street Address
Street Address
Please don't forget City State/Pro.
Please don't forget City State/Pro.
Zip/PO # Cntry
Zip/ PO # Cntry
Your Phone (Optional)
Your Email Address (to process your
order)
Payment Method:
If you are paying by check from any
location outside the U.S., kindly send an email request to cornplanter@earthlink.net
for the exact amount for your location. Just tell us which number item it is in the
"Order List" in the Drop Down Menu above and tell us your City, Province,
Country, and Postal Code. An email bill will be sent to you telling you the exact amount
for all applicable charges for taxes and shipping. Then you can send a check and when the
amount is received, the product will be shipped. Referred by:
Total
Amount sent by check: ___________
Visa or Mastercard
Card # --- Please type in only the numbers; NO dashes - NO
spaces
Expiration Date: Month: Year:
Date
of Order: Please use only numbers
Month:Day:Year:
Cosmic Catalog For 
Minds 