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.
___Cashier’s Check or Money Order
___Credit Card (Please ensure the address above matches the Credit Card’s 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!