ORDER FORM
FOR NEW ZEALAND ALTERNATIVE LIFESTYLE RESOURCE DIRECTORY
 

To complete your order please complete the following form:


Today's Date:   
Name:                
Address1:            
Address2:           
Town/City:              
State:           Zip Code:       
Province:       
Country:        
Your E-Mail Address?    (Only for us)
Your Internet Address?


We Accept:

Select payment form: 
Card Number:  
Credit Card Expiration Date:   Month    and Year 


Name on Card: 


(All information submitted remains confidential) 
Credit Card billing will appear on your statement as MTC (Our credit card service provider)


 Please make checks and money orders payable to: 
Larry Smith
Mail to: 3619 E Verdin Road, Phoenix, AZ 85044 (USA)

or

If you prefer, you may call us at 480 899 4463 USA and enter your order.

Alternative Lifestyle Resource Directory (New Zealand), $5.00 (U.S.) + S&H $1.50

karinya@interwrx.com

THANK YOU FOR YOUR INTEREST!
PLEASE COME VISIT KARINYA
and The Alternative Lifestyle Directory again. New things are in the works!

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