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CONFIDENTIAL - MAIL IN APPLICATION & ORDER FORM Name_________________________________________N/C PLEASE PRINT Additional names * under which you plan to receive mail. 1___________________________N/C 2 _____________________________$10 2___________________________$10 4 _____________________________$10 5___________________________$10 6 _____________________________$10 * FIRST TWO NAMES - FREE EACH ADDITIONAL NAME IS $10 PER NAME PER YEAR OR LESS ADDRESS MAIL IS TO BE FORWARDED TO: ________________________________ Street or P.O. Box _____________________________________ Apt. #__________ City ____________________________ State or Province ___________________ Country___________________________ Zip or Postal ______________________ Phone (______)____________________ Fax (______)______________________ Your e-mail __________________________________________________________ ------------------------------------------------------------------------------------------------------------------- What items below do you wish us to accept or not accept for you. REGISTERED MAIL YES NO CERTIFIED MAIL YES NO COURIERS (UPS, FEDEX) YES NO PACKAGES YES NO ACCOUNT SECURITY PASSWORD _____________________________________ How did you learn about our services ? ____________________________________ The account security password is used to verify that it is you, if you happen to call us about your account. We will ask you for the security password so we know it is you. ------------------------------------------------------------------------------------------------------------------ Pick the term length you are subscribing for: US FUNDS ONLY 5 YEARS $500_______ 2 YEARS $250 __________ $ _________ 1 YEAR $150 _______ 6 MONTHS $85 _________ $ _________ Add some fund for us to use as postage on the mail we forward to you. $ _________ Emergency Phone Service fees will be deducted from postage balance $ _________ Calls or labels for you or anything else you may want. Minimum $30.00 $ _________ Additional names * (circle one) 1 2 3 4 5 @ $10 ea $ _________ SAFEKEEPING - Add 50% of Service Fee for the term chosen $ _________ ---------------------------------------------------------------------------------------------------------------- E-MAIL SERVICE - N/C - Remail an e-mail rec'd here for you. $ _________ FAX SERVICES - $1.00 per page outgoing or incoming. $ _________ EMERGENCY PHONE CALL SERVICE - $10.00 each $ _________ POST CARD SERVICE - $3.00 each $ _________ GOLD COINS - $30.00 per coin plus actual coin cost + S & H. $ _________ ------------------------------------------------------------------------------------------------------------------ PERSONALIZED LABELS Quantity _____ Circle 1 Transparent #929 Flag #941 Gold Foil #928 $12.00 per 200 plus postage to mail them to you. $ _________
Labels to be printed as follows Line 1 ___________________________________________________Please Print Line 2 ___________________________________________________ Line 3 ___________________________________________________ Line 4 ___________________________________________________ ------------------------------------------------------------------------------------------------------------------ RUBBER STAMPS Quantity ______Size: - 1.5 inch at $16 2 inch at $17 2.5 inch at $18 We will mail all rubber stamps to you via First Class - Air mail. $ _________ Rubber Stamp to be printed as follows Line 1 ___________________________________________Please Print Line 2 ____________________________________________ Line 3 ___________________________________________ Line 4 __________________________________________ Each additional line is $3.00 each ----------------------------------------------------------------------------------------------------------------- INDIVIDUAL LETTER SERVICES For account holders - we deduct the fee(s) from your postage fund For Non Account Holders - Include funds with letter(s) being remailed Remailed from our area to anywhere in N.A Quantity_____@ $3 each $ __________ Remailed from our area outside of N.A Quantity_____@ $4 each $ __________ Remailed International Quantity_____@ $15 each $ __________ Remailed in North America Quantity_____@ $10 each $ __________ ------------------------------------------------------------------------------------------------------------------ CHEQUE or BANK DRAFTS Which currency ? Circle 1 US$ CDN $ OTHER __________ Amount of check $ ________plus $10.00 per check $ ___________ Amount of Bank Draft or M.O. or Cashiers Check $ ___________ Plus $15.00 per item to a maximum of $2,000.00 per item. $ ___________ For items over $2,000.00 call, mail, fax or e-mail us for a quote. TOTAL ENCLOSED $ ___________ ----------------------------------------------------------------------------------------------------------------- If you have previously been assigned an account number as a result of speaking with us by phone or fax or e-mail, please indicate the account number given. ____________________ ----------------------------------------------------------------------------------------------------------------- SPECIAL INSTRUCTIONS OR COMMENTS __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ Wayne Budd Incorporated P.O. Box 460, Madoc Ontario, Canada K0K 2K0 Phone
613-473-4838 Fax 613-473-4332 |
The Official Remailing Guide Index