EMedia Professional - Order Form

BILLLATER
CHECK or MONEY ORDER

To be billed later, or to order EMedia Professional by check or money order just print the following order form, fill in the appropriate information, and mail or fax to:

EMedia Professional
Attn: Rebecca Manis
P.O. Box 401
Mt. Morris, IL 61054-0401
Fax, 815/734-5827

SUBSCRIPTION INFORMATION

EMedia Professional is a monthly publication. Subscriptions are available at the following rates (charges subject to change without notice). Please indicate the type of subscription you require:

Basic personal rate, 12 issues at $39.95/year
Corporate rate, 12 issues at $98/year
Canada, add $9 postage - 12 issues at $48.95/year
International, add $50 postage - 12 issues at $89.95/year

Please indicate your billing preference:

Bill later
Payment included

SHIPPING ADDRESS

FIRST NAME:____________________________________________________


LAST NAME:_____________________________________________________


COMPANY NAME:__________________________________________________


STREET ADDRESS:________________________________________________


P.O.BOX:_______________________________________________________


CITY:__________________________________________________________


STATE:_________________________________________________________


ZIP:___________________________________________________________


COUNTRY:_______________________________________________________


TELEPHONE:_____________________________________________________


DATE: _________________________________________________________


SIGNATURE (required): _________________________________________

[For office use only: Pubcode: ROMD, Sourcekey: TWEB]

Make check or money order payable to Online Inc. in U.S. dollars from a U.S. bank. For more information email: emediasub@onlineinc.com (be sure to include your mailing address and telephone number), or call 800/806-7795, or outside U.S., call 815/734-1146.

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