|Street Address & Unit #:||_______________________|
|City / Province / State:||_______________________|
|Postal Code / Zip Code:||_______________________|
|Email (if applicable):||_______________________|
|Website URL (if applicable):||_______________________|
I, ____________________ have read and agree with the Terms & Conditions and have purchased the Package Type (circle one) A B C (see info). The contract is for ______ months. I have agreed to pay the total charge for the package $US__________ which will be paid to Afghan Network iNteractive. A receipt with details of the contract will be either emailed or delivered to your business address within 15 business days of payment .