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  AD PAYMENT FORM

This form allows you to pay for your display or classified ad online. You may only pay for an ad that you have received a bill for in the mail. You may not pay for an ad that you have not yet placed or have not received a bill for.

All fields have to be filled.


INVOICE NO. (located on your bill)
Company
(listed on the ad)
Phone
E-mail Address
Repeat E-mail
(for security)

Please make sure your email 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 (xx/xx)


Billing Address
First Name
Last Name
Address 1
Address 2
City
ST/PROV
ZIP+4
Country

Check here if you wish to cancel your ad in the NEXT issue

All fields have to be filled.


 
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