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The
Media Source, Inc.
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Alura
Subscription Order Form
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Please print out this
form, fill it out completely, then sign it at the bottom and fax it to
The Media Source, Inc. at (713) 622-8211 - or mail it to us at the address
given at the bottom of this page. Once we have processed your order form
you will receive Alura each month by subscription on the date(s)
you have chosen.
Name ________________________________________________________
Address ______________________________________________________
City ________________________________
State ____________________
Postal Code ________________
Country (if not USA) ___________________
How much Alura
do you wish to receive on a recurring basis? (Check one)
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1 Packet - $15.00 per month |
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3 Packets - $45.00 per month |
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2 Packets - $30.00 per month |
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4 Packets - $60.00 per month |
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6 Packets - $90.00 per month
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| NOTE:
Price does not include shipping and handling charges. Texas residents
will be charged 8.25% sales tax. |
On which date each
month would you like us to ship your order? (Check one or both)
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On the 1st day of each month |
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On the 16th day of each month |
| NOTE:
If the date falls on a weekend or holiday, your order will be shipped
on the next business day. |
How would you like
to have your order shipped? (Check one)
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Standard US Mail (3-7 days)
add
$4.99 shipping and handling/month
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2 Day Priority Delivery
add
$6.99 shipping and handling/month |
Credit Card Information
Credit Card Type: ___ Visa ___ Mastercard ___ American Express ___ Discover
Name on Credit Card ____________________________________________
Credit Card Number ____________________________ Expires __________
By signing and faxing
or mailing this document, I agree to the following:
- I am at least 21
years of age or older.
- I am the legal
holder of the above listed credit card.
- I hereby authorize
The Media Source, Inc. to use the above credit card information to pay
for my order each month from this date forward, on the date(s)
I have chosen above.
- I understand that
I will continue to receive the product(s) I have ordered with this form
on a monthly basis, each and every month, unless I notify The
Media Source, Inc. to discontinue this order in writing, using
the contact information given below.
- I understand that
while The Media Source, Inc. will diligently work to ship my order on
time, I hold The Media Source, Inc. and its agents harmless in the event
my order fails to reach me in a timely fashion.
- I understand that
all orders I receive are non-refundable, although I can discontinue
receiving future orders at any time I choose by notifying The Media
Source, Inc. in writing, using the contact information given below.
Signed: _________________________________ Date: ___________________
Send this order (or
any written notice to discontinue this order) to:
- Fax: (713) 622-8211
- Mail: Alura
Subscription - The Media Source
PO Box 740653 - Houston, TX 77074-0653 USA
Have
questions? Call us directly at 1-800-848-5928
Monday through Friday 8 AM - 5 PM
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