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Woods 'n Water
3427 Puckett Rd. Perry, Florida 32348 Fax: (850) 584-4217 (Print and fill out this form. Mail or fax using the information above.) |
My Subscription
[ ] 1 year - $16.95 [
] 2 years - $29.95
| Name: ____________________________________ |
| Address: _____________________________ Apt/Box#: ____________ |
| City: _________________________ State: ________ Zip: ________ |
| Phone number: ( ) _____________ Ext: ________ |
| My last subscription expired about: ___/___ /___ |
Gift Subscription
[ ] 1 year - $16.95 [
] 2 years - $29.95
| Name: ____________________________________ |
| Address: _____________________________ Apt/Box#: ____________ |
| City: _________________________ State: ________ Zip: ________ |
| Should we send an Announcement card? [ ] yes [ ] no |
| Sign the card from: _______________________________ |
Method of Payment
| Amount: $__________ |
| [ ] Check or Money order (payable to Woods 'n Water) |
| [ ] Credit card [ ] Visa [ ] Mastercard |
| Card holder name: _______________________________ (please print) |
| Card number: _______________________________ |
| Expire date: ____/____/____ Billing Zip: __________ |
| CVC Code (last 3 digits on back of card): _________ |
| Signature: __________________________________ |
