Mail Box Order Form

COMPANY NAME:
STREET:
CITY:
STATE:
ZIP:
CONTACT NAME:
E-MAIL ADDRESS:
MAIL BOX NAMES:

The charge for a Mail Box is as follows:

1. Monthly site fee $ 5.00 per month each X # of Boxes: (e.g. for 5 boxes, 5 X 5 = $25.00)
2. Site Set-up charge: $ 49.00

$ 49.00

TOTAL Charge (line 1. plus line 2.)


For payment by Check of Money Order, make it payable to "Surfpage" for the TOTAL Charge and mail to:

SurfPage
PO BOX 17053
Long Beach, CA. 90807

For payment by credit card (VISA or Master Charge) call 310-989-6656 or complete the following:

CARD TYPE: MasterCard Visa

CARD NUMBER:  

EXPIRITION DATE:  

NAME (Cardholder):  

Press on Submit Form to enter your order and to indicate that you have read and accepted the Terms and Conditions of Sale.

The above charges are a quarterly fee and due before the service is activated and can be accessed. Subsequent fees are payable annually on the same day that the site was activated.