________________Optional (Initial Here)   Please add $39 for the design of my email ad.

__________________ Total Purchase Amount

Notes: ________________________________________________________________________________

________________________________________________________________________________
 

Payment Options

1)  All Major Credit Cards.... All information on this form must be completed.    Then FAX this Signed Order Form to   (603) 994-1746.
.
2)  Mail a Check/Money Order:  Make PAYABLE TO:  "Petron Plus"

Mail To:  1515 Buena Vista, Unit P, San Clemente, CA 92672.
NOTE:   Allow 4-5 business days for checks to clear.
.

** Credit Card Orders, please complete the following information.
.
VISA_____      MC_____       Discover_____     *** NO AMERICAN EXPRESS
.
Card Number___________________________________________ Ex. Date______
.
Name on Card_______________________________________________________
.
Billing Address______________________________________ ST___ Zip________
.
Phone Number_________________________  Fax Number __________________
.
* Email Address_________________________________
 
 
 

OPT-IN EMAIL  ORDER FORM / INVOICE        Page 2
 

I understand that AdMax Marketing is only responsible for delivering my/our ad to the total amount agreed upon, and to the list indicated above.

I understand that advertising response rates vary due to many factors, and that AdMax Marketing can not; therefore, does not guarantee sales or response.   (AdMax Marketing Guarantees Delivery Only.)

I authorize AdMax Marketing (dba Petron Plus-CA) to debit my account for the purchase amount  indicated above.

I agree here to waive the requirement for a physical imprint of my credit credit, as I'm making this purchase from my home or office, via facsimile machine.

_______________________________________________________           _________________
SIGNATURE of CARDHOLDER                                                                   DATE