Fax orders for Dawn's Place LLC : If you would like to pay for your membership by credit card via fax, please print out this page and fill in the items. Please remember to sign the bottom of this page. Fax Number: 1-661-257-0914 Username ___________________________ Credit card # _____________________________ Password ___________________________ Expiration date____________________________ CVV2# ______________________________ First Name ______________________________ Last Name _____________________________ Address ____________________________________ City ____________________________ State___________________________________ Zip/Postal Code ______________________ Country ____________________________________________________ Birth Date ___________________________________________________ Drivers License # ___________________________________________________
Order Option Selection - $29.95/Month Recurring,
$39.90/2 months Recurring
I declare under the penalty of perjury to the following:
I am at least 21 years of age.
I am not affiliated with any postal or law enforcement agency. I agree to the terms and conditions listed on the website. By placing a credit card order online, you infer compliance with the above statement. Signature ___________________________________________________ Feel free to call once you send the fax, to confirm that your fax has been received. Click here to read the terms and conditions. |