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Please print out this page and mail or fax to:

Publisher, BE THE MEDIA
natural E creative group
1110 Jericho Turnpike
Second Floor
New Hyde Park, NY 11040
Tel: 516 488-1143
Fax: 516 488-4111

We accept check, money order or credit card
 Visa Mastercard Discover American Express eCheck
Visa, Mastercard, Discover or American Express


Name: ___________________________________________
Title: ___________________________________________
Organization: ___________________________________________
Address: ___________________________________________
City/State/Zip: ___________________________________________
Phone: ___________________________________________
Fax: ___________________________________________
E-mail: ___________________________________________

Item

Quantity

Unit Price

Amount

"Be The Media" Book

 _______

$ 34.95  $ ______________
Sales Tax* (see below)

 _______

_______  $ ______________
Shipping** (see chart below)

 _______

_______  $ ______________
TOTAL:

 _______

_______  $ ______________

Check enclosed (Payable to Natural E Creative, LLC): $ ____________

* Sales Tax
: California residents add appropriate sales tax
** Shipping: Please allow 4-5 business days for shipping.
We use the following UPS standard shipping rates:
Order Total          Add for shipping
$0 to $34.99                 $ 4.95
$35 to $49.99               $ 5.50
$50 to $99.00               $ 7.00
$100 to $199.99            $ 8.50
$200 +                       $ 10.00

Please call for 2-day or next-day Federal Express delivery (516) 488-1143.


OR PAY BY CREDIT CARD...

Visa         MasterCard        Discover         American Express
Please note: There is a $3.25 processing fee for using credit card.

Name (exactly as it appears on card): ______________________________
Card number: ______________________________
Verification Number (on back): ______________________________
Expiration date: ______________________________
Total to be charged: ______________________________
Signature: ______________________________

IMPORTANT - In order to process your credit card we are required to enter the following fields:
Credit Card Billing Address - Enter the address where you receive your credit card bills.
Phone Number - Enter the phone number you use for billing contact on this credit card.
Email Address - We use your email address to send you a receipt of this transaction.
This information is confidential! Natural E Creative will NOT share this information.
We DO NOT give out, sell or share our customer list.

Address: ___________________________________________
City/State/Zip: ___________________________________________
Phone: ___________________________________________
E-mail: ___________________________________________


Thank you for your order!


All contents Copyright 2002-2010 natural E creative group. All rights reserved.