1000 Name Mailing List Order Form

PLEASE FAX OR MAIL A COPY OF YOUR MAIL PIECE WITH YOUR ORDER TO THE MSI FAX NUMBER OR MAILING ADDRESS BELOW

Please fill out form clearly and completely, and 
Mail to:
MSI
1048 Irvine Ave #350 NewPort Beach   CA   92660
Fax to:
806-209-0970
email to:
orders@mailingteam.com

Name:________________________	Date: ____ / ____ /____
Physical Address:____________________	Phone:(_____)_____________
City: ________________ State _____ Zip: _______ Company Name________________________ Program Name_________________________	Fax:	(_____)_____________

Email Address: _______________________________________

Maximum order is 1000 names per order.

Price is $150.00 per thousand including shipping and handling

Payment Method:
Visa__   Mastercard__   AmericanExpress__   Money Order__   Cashiers Check__
 
Visa/MC/AMEX   # __ __ __ __   __ __ __ __   __ __ __ __   __ __ __ __
     
Expiration Date:___-___
 
Security 3 Digit Code on Reverse above Signature: __ __ __ or
4 Digit Code on front of AMEX Card: __ __ __ __

Credit Card Billing Address_______________________________________

____________________________________________________________

 Address above is OK for billing    Yes___   No___

Cardholder Name________________________

Signature__________________________________


ALL SALES ARE FINAL. CANCELLATIONS, CHARGEBACKS OR RETURNS ARE NOT ALLOWED.

All list rentals are for one time use only.   All orders are final, non-cancelable and nonrefundable without special permission, in which case, cancellation and other charges may apply.   Although we do our best to provide fresh, responsive names, no guarantee is made either explicitly or implied as to the deliverability or responsiveness of any name or list provided.