To send your order via postal mail please print and mail the completed form to: Mystik Media 296 Captain Beam Blvd Hampstead, NC 28443 Product and purchase information: Merchant name: Mystik Media Description: Blaze Media Pro Purchase amount: $50.00 Product ID: ______________________ (Found in bottom left corner of the Purchase window) Billing address information: Name:_______________________________________________________________ Street (Line 1): ________________________________________________________ Street (Line 2): ________________________________________________________ City: ________________________________________________________________ State / Province: _______________________________________________________ ZIP / Post Code: _______________________________________________________ Country: _____________________________________________________________ Phone: ______________________________________________________________ E-mail: ______________________________________________________________ Payment Type Select your type of Payment: ___Personal or business check. It usually takes 2 to 5 business days after receipt of the check for the bank to process the check. Once the check has been processed the activation code is e-mailed to you within 48 hours. (Attention: There is a $25.00 charge for all returned checks.) ___Cashier’s Check or Money Order ___Credit Card (Please ensure the address above matches the Credit Card’s business address. Credit Card Information If paying with a credit card please supply the following information: Card Type: ____________________________________________________________ Card Number: _________________________________________________________ Expiration Date: ________________________________________________________ Signature: _____________________________________________________________ Thank You For Your Order!
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