|
Mail In
GIFT Subscription Form |
|||
|
PAYMENT INFORMATION |
|||
|
Payment Type (circle):
Check Money Order
|
|||
|
Credit Card Number |
|
||
|
Expiration Date |
|
||
|
Name on Card |
|
||
|
Signature (must be signed on Credit Card Orders) |
|
||
|
SENDER INFORMATION |
|||
|
Your Name |
|
||
|
Your Address |
|
||
|
Your City |
|
||
|
Your State |
|
||
|
Your Zip |
|
||
|
Your Country |
|||
|
Your email address (optional) |
|
||
|
GIFT RECIPIENT INFORMATION |
|||
|
Their Name |
|||
|
Their Address |
|||
|
Their City |
|||
|
Their State |
|||
|
Their Zip |
|||
|
Their Country |
|||
|
Their email address (optional) |
|||
|
SELECT YOUR GIFT SUBSCRIPTION (check one) |
|||
|
STANDARD GIFT SUBSCRIPTION |
DELUXE GIFT SUBSCRIPTION | ||
|
US/Domestic |
$28.95 |
US/Domestic |
$43.90 |
|
Canadian |
$43.95 |
Canadian |
$63.90 |
|
International |
$84.95 |
International |
$110.90 |
| SELECT YOUR T-SHIRT GIFT (check one) | |||
| Sizes Medium and XL | $19.95 | Sizes XXL and XXXL | $22.95 |
| Shipping & Handling | US/Domestic | $3.00 | |
| Canadian | $5.00 | ||
| International |
$10.00 |
||
| SELECT YOUR CALENDAR (check one) | |||
|
US/Domestic |
$14.99 | Shipping & Handling included | |
|
Canadian |
$19.99 | Shipping & Handling included | |
|
International |
$24.99 | Shipping & Handling included | |
|
Conditions Legendary Ford Magazine P.O. Box 2707 Grants Pass, OR 97528-0285 |
|||