ORDERED BY:
Name _________________________________________________________________
Address _________________________________________________________________
City _________________________ State ________________Zip ________________
Country ______________________ Phone ____________________________________
E-Mail Address __________________________ 800# __________________________
Telephone ________________________ Fax# _________________________________
I will accept from clients (viewers) the following payment methods
for my listing or products I have: (check one or all)
[ ] Check [ ] Money Order [ ] American Express
[ ] Discover [ ] VISA [ ] MasterCard
| ORDER NO. |
DESCRIPTION |
TOTAL
(U.S. Funds) |
Basic
|
One-time setup ($25.00) and monthly costs ($15.00 -
Listing) |
$40.00
|
OPTION 1
|
On-Line Ordering per month @$20.00
|
|
OPTION 2
|
Punch and Pizzaz Logo per month @$10.00
|
|
OPTION 3
|
Credit Card Acceptance ($1.00 per transaction)
|
|
OPTION 4
|
My own personal brochure @ $500.00
(Master copy only) |
|
OPTION 5
|
Please provide a quote for my own full page. |
(No charge) |
Basic Setup/first monthly costs $55.00 + Options____ = Total Order_________
Please accept this registration form and the enclosed check or money order
payable to Larry Smith Associates in the amount of $55.00, representing
a one-time registration fee of $25.00, the first month's listing rental
(minimum of $15.00), and the server and storage cost of $15.00 for the first
month for the initial setup and basic monthly cost plus any options included
(w/$ amounts entered into the above form).
(Larry Smith Associates reserves the right to edit, accept or reject any listing
if it does not, in their opinion, conform to KARINYA standards and suitability.)
Signature __________________________________________________________________
Thank you for your interest and your registration and order form!
© 1995-2001 Larry Smith Associates
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