TELEDUCTION - Fax/Mail Order Form

Tax Spots - Fax/Mail Order Form
Tax Spot Package Price is $950.00 plus $10.00 S&H which includes customization of television spot, (1) BetaSP tape containing English and Spanish Television Spots, and (1) CD containing English and Spanish Radio Spots to be customized at your local radio station. Please allow 2 weeks for delivery.
Please be sure to fill form completely, then print to fax or mail.

CUSTOMIZATION for TELEVISION SPOT

Line 1		Recommendation: Telephone
Line 2		Recommendation: Website
Line 3		Recommendation: Company

BILLING INFORMATION

SHIPPING INFORMATION (if different)

Credit Card
Cardholder Name
Card Number
Expiration
Address
Address2
City
State
Zip Code
Phone
E-mail

Name
Address
Address2
City
State
Zip Code
Phone
E-mail

ADDITIONAL INFORMATION

Please add any pertinent information

Fax this completed form to TELEDUCTION at (302) 429-7534
OR
Mail this completed form to:
TELEDUCTION, 954 S. Madison Street, Wilmington, DE 19801

You may also mail order form with check or money order to above address.