FAX/Postal Mail Form

To send your order via postal mail please print and mail the completed form to:

 

Mystik Media
296 Captain Beam Blvd
Hampstead, NC 28443

Fax:  775-924-4436

 


Product and purchase information:

 Merchant name: Mystik Media
 Description:
 AutoImager
 Purchase amount: $60.00
 Product ID:  ______________________ (Found in bottom left corner of the Purchase window)


Billing address information:

Name:_______________________________________________________________

Street (Line 1): ________________________________________________________

Street (Line 2): ________________________________________________________

City: ________________________________________________________________

State / Province: _______________________________________________________

ZIP / Post Code: _______________________________________________________

Country: _____________________________________________________________

Phone: ______________________________________________________________

E-mail: ______________________________________________________________


Payment Type

Select your type of Payment:

 

___Personal or business check. It usually takes 2 to 5 business days after receipt of the check for the bank to process the check. Once the check has been processed the registration code will be e-mailed to you within 48 hours.

Attention: There will be a $25.00 charge for all returned checks.

___Cashierís Check or Money Order

___Credit Card (Please ensure the address above matches the Credit Cardís business address.


Credit Card Information:

If paying with a credit card please supply the below information:

Card Type: ____________________________________________________________

Card Number: _________________________________________________________

Expiration Date: ________________________________________________________

Signature: _____________________________________________________________

 

Thank You For Your Order!