You can use this form to place an order by credit card or CyBank.

To order using CyBank you must go to their site and open an account first. It is FREE to open. Just click on the CyBank Banner that is on the ordering page. You can charge your opening balance to Cybank on your TELEPHONE BILL if you wish!

Type of Ad:

Your Comments:

First Name: M.I.:
Last: Sponsor:
Credits: Purchase Amount:

SELECT YOUR CO-OP:
Member (Ad Co-op only) Business Building Member Both

To use your credit card, either Visa, Mastercard, American Express, Diner's Club, or Discover,fill out the form below.

Card Holder: Card-Number:
Expiration Date:

To use your Cybank account, fill out the form below.

Cybank Name: Cybank Account#:

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