Mail Forwarding Service Order Form  

The charge for this service is $15 per month, payable 6 months in advance, plus postage for mail forwarded to you. This service is limited to letters and correspondence not exceeding twenty pages. There is a surcharge of $25 per item for the receipt of packages weighing 10 lbs or more. Packages larger then 10 lbs cannot be accepted and therefore will be returned to sender.

Contact Information:
Company Name:
State of Incorporation:
Contact Name:
Phone:
Fax:
Pager:
E-Mail:
Forwarding Address:
Individual or Company Name Addressed To:
Address:
City:
State:
Zip:
Country:
Forwarding Instructions: Credit Card Information
Name on Card:
Billing Address of Credit Card:
City:
State:
Zip:
Billing Phone Number:
6-months Service $90 12-months Service $180
Postage Deposit	U.S. Dollars (Minimum Deposit Required is $25) * If you received an invoice from our mail forwarding department and it doesn't require a postage deposit, enter a zero value above for postage deposit.
Amount In US$ to be Charged on Card:	*Total Amount Due from Invoice, if applicable.
*Minimum amount is $90 plus postage for mail forwarded to you. If you are unsure about total amount for postage due contact info@amerilawyer.com
Payment Options :	Visa Mastercard American Express Discover Diners Club Paypal Google Checkout	PayPal or Google Checkout Email Address:   PayPal or Google Checkout Payment Instructions: If you are going to process your order with a PayPal or Google Checkout account, provide us with the email address associated with your account.
Card Number:
Expiration Date: xx/yyyy
Enter 3 or 4 digit security code for your credit card:

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By submitting this order you understand that the above amount will billed to your credit card.