| Full Name: |
_______________________ |
| Business Name: | _______________________ |
| Street Address & Unit #: | _______________________ |
| City / Province / State: | _______________________ |
| Postal Code / Zip Code: | _______________________ |
| Telephone: | (____)__________________ |
| Email (if applicable): | _______________________ |
| Website URL (if applicable): | _______________________ |
Contract Details:
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 .
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____________________ |
_____________________ |