Order by mail
(Print Form)
| Enter site name here :_________________ | Membership Options | Price per Item | Total |
| Enter site's URL here: _________________________________ |
Please include the site name. |
Please include your email address. |
_____ |
| Enter YOUR email address here: _________________________________ |
3 months | $20.00 | _____ |
| 6 months | $30.00 | _____ | |
| 1 year | $50.00 | _____ | |
| All user information must be filled out. |
REQUESTED USER ID: _______________ |
REQUESTED PASSWORD: ___________ |
x_______________
Please sign here
Please make Check or Money
Orders payable to:
Michael Gardner
Mail order form to:
HiRise Entertainment
Inc.
1027 Friedrichs st.
Gretna, LA 70053
ONLY U.S CASH, U.S CHECK and U.S.
MONEY ORDERS ACCEPTED