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ListGal Order Form
Date ________________
Company_____________________________
Name________________________________
Address______________________________
City, St, ZIP________________________________
Phone1___________________ Ph2______________________
Fax___________________
Email_____________________________________
Items_______________________________$__________
_______________________________$__________
_______________________________$__________
_______________________________$__________
Signature_____________________________________
Pay By Check
Make payable to "The List Guy". Then Fax this form along with completed and signed USA check to 760-454-2738 or Mail this form with check or Money Order to: POBOX 4447, OCEANSIDE, CAL 92052
TAPE YOUR CHECK HERE
Sometimes the print on a check is difficult to read after the fax process. Please take a moment and fill in all the blanks. The “answers” to the questions are contained on the face of your check.
1) ABA NUMBER: _________________________________________________
In the upper right quadrant of your check. Usually small. May look like: 70-7026/2711
2) TRANSIT NUMBER _______________________________________
Always 9 digits beginning with 0,1,2 or 3 and has “Smiley Faces” in front and back.
3) ACCOUNT NUMBER _____________________________
4) CHECK NUMBER _____________________________
5) BANK NAME & BRANCH _____________________________
5) BANK ADDRESS _____________________________
______________________________________________________________________
Name (on check) _________________________________________
Address _________________________________________
City, State & Zip _________________________________________
Signature (as on check):
Plz sign to the right in clear white space
PLEASE SIGN CHECK AND IN THE CLEAR, WHITE SPACE ABOVE.
RETURN VIA FAX TO 760-454-2738 OR EMAIL INFO@LISTGUY.COM
Pay By Credit Card
CREDIT CARD: Visa__ / MasterCard__ / Discover__
Card # _________________________________________
Expiration mmyy _______ / 3 Digit Security Code ____
Signature_______________________________________
Pay By Wire/Bank Transfer/Western Union/Money Gram
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