To : ___________________________
From : Sales
Phone # ______________________ Email : dream . teen @ aol . com
AUTHORIZATION FOR ADVERTISEMENT
_________ ID : By entering my initials in on the line , I agree that spelling , content and layout are correct . I understand that my document will print exactly as it appears in email format or any other electronic format and that I cannot make any changes once my order has been placed for such issue .
CREDIT CARD AUTHORIZATION FORM DREAM MAGAZINE
I _________________________, hereby authorize DREAM MAGAZINE , processed by PERFECTING PRAISE MINISTRIES to process my payment for advertising in DREAM MAGAZINE by :
Credit Card Type : ____________________________ Today ’ s Date ______/_______/ __________ My Credit Card number : _______________________________________ ( Amex not accepted ) Name As is on Credit Card : _________________________________________ Billing Address : ______________________________________________ City __________________ State _____________ Zip Code ____________
Telephone Number : ___________________________________________ Authorization Code ____________________ Credit Card Charges $ _________________
Authorization Signature : _______________________________________ Invoice Amount : $ _____________________
Total Charge :
$ _____________________
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To Be Completed by Account Executive Advertiser ’ s Representative : _______________________________ Company Name : ________________________________________ Issue - Month __________________________________________ Page Size _____________________________________________ Specs _________________________________________________
Signature of Executive ____________________________________ Date ______________________
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