| Distributor Payment Form
This
form allows you to pay for the magazines you receive as a distributor
of Primitive Archer Magazine.
All fields have to be filled.
INVOICE NO. (located on your bill)
Company
Phone
E-mail address (please make sure your address is correct, a receipt will be emailed to this address)
Method of Payment in US funds only!
Master Card Visa
Name on Credit Card
Credit Card Number
Exp date
Billing Address
First name
Last name
Address 1
Address 2
City
ST/PROV
ZIP+4
Country
All
fields have to be filled.
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