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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 or American Express
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Name: |
___________________________________________ |
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Title: |
___________________________________________ |
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Organization: |
___________________________________________ |
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Address: |
___________________________________________ |
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City/State/Zip: |
___________________________________________ |
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Phone: |
___________________________________________ |
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Fax: |
___________________________________________ |
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E-mail: |
___________________________________________ |
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Item |
Quantity |
Unit Price |
Amount |
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"Be The Media" Book |
_______ |
$ 34.95 |
$ ______________ |
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Sales Tax*
(see below) |
_______ |
_______ |
$ ______________ |
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Shipping** (see
chart below) |
_______ |
_______ |
$ ______________ |
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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.
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Name (exactly as it appears on card): |
______________________________ |
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Card number: |
______________________________ |
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Verification Number (on back): |
______________________________ |
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Expiration date: |
______________________________ |
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Total to be charged: |
______________________________ |
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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.
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Address: |
___________________________________________ |
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City/State/Zip: |
___________________________________________ |
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Phone: |
___________________________________________ |
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E-mail: |
___________________________________________ |
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