M&A Computer Services Newsletter Ad
Order Form

Please do not use this form anymore, here is a new one:
NEW E-Zine AD ORDER FORM
 
Customer Information:

Customer Name:
Company: 
Address:
City: State: Zip:
Telephone:
Fax:  
E-mail:

Products/Services:

Qty. Description

 

Ad's in Our Weekly Classified Only Newsletter Edition (Co-Op Advertising)

 

 

Cut & Paste Your Ad Here:  (If you don't have the ad ready yet, simply email your ad to: adorder@manda1.com when you are ready.  Make sure to send it from the same email address you used above.)

Payment Options:

1) Pay by Credit Card

2) Check by Email (Fill out this form completely and simply press the submit order button at the end of the page.)

3) Check by Fax (Fill out this form completely, print and fax this form to M&A at: (937) 687-1328. NOTE:  Don't hit the submit button if you choose this option.)

4) Check By Mail (Fill out this form, print and mail to address below, along with your check or money order. NOTE:  Don't hit the submit button if you choose this option.)

5) X.com  - We now accept payment via x.com.  Simply check this box and we'll request a payment from you.  You'll have to sign up for an x.com account if you don't have one.

 

NOTE: For Options 2 & 3 Only, Fill out the following Information: (We Only Ship or Perform Service after check clears, usually 10 business days)

Name On Check (If diffirent from above):
 NOTE:  Your bank will tell you any of this info if you can't find it.
Bank Name:
 Bank Address:
Federal Reserve Number (Fraction in upper right hand Corner): Check Number:
Routing Number (Always 9 Digits):
 Checking Account Number:

For Option 3, Please send the total amount to:

M&A Computer Services
2 N Church St
New Lebanon, OH 45345
Phone/Fax (937)687-1328

Comments:

Thank You For Your Order!