Order

Midtown Mailbox & Business Centre
Secure Online Order Form

Customer Information:

Customer Name:

Address:

City: State: Zip:

Telephone:

Fax:

E-mail:

Product Order Form

NLRS-001	1 Pak	$39.00	$
NLRS-010	10 Pak	$200.00	$
NLRS-025	25 Pak	$375.00	$
NLRS-050	50 Pak	$500.00	$

BC. Residents add 7.0% Provincial Sales Tax:
Total of This Order:

Note: All orders shipped within 24 hours of payment.

Payment Options:

Pay by Credit Card

Card: Card Number:
Expiration Date:

Pay by Check (All Virtual Checks are payable to: Midtown Mailbox)

Charge To Bank Name:

Bank City: Bank State:

Bank Routing, Transit and Account Codes:

(Enter all digits at bottom of check. Use dashes in place of brackets)

Check Number:

Debit / Charge Authorization:

I understand that by entering the "Total Amount Authorized for Debit", signing in the "Authorizing Signature" and submitting this Order Form for processing, I am authorizing Midtown Mailbox & Business Centre. To debit my checking account or credit card for the products and / or services I have specified in the Order Form section above.

Total Amount Authorized for Debit :
(Enter Order Total, including any applicable shipping fees. BC. residents add 7.0% Provincial Sales Tax)

Authorizing Signature:
(Enter name on checking and/or credit card account)

Order Processing Information and 30-Day Money Back Guarantee:

Midtown Mailbox processes orders daily via an automated batch transaction process. Upon verification and approval of your selected payment method, Midtown Mailbox will immediately process your order. All orders received will be processed within 24 hours of receipt.

All products and services offered by Midtown Mailbox are backed by a 10-day Money Back Guarantee (less shipping & handling). All returned products must be in resaleable condition.

Thank You For Your Order!