| |
50 Day Street Norwalk, CT 06854 • Tel 203-663-7858 • Fox 203-852-8175 • theresa@busjour.com
Publishers of Accent, Accessories, Fashion Forum, MR, Turbomachinery International
|
|
|
| |
BILL TO :
#BILLTO_NAME#
ATTN: #BILLTO_CONTACTNAME#
#BILLTO_ADDRESS#
Account No: #BILLTO_ID# |
ADVERTISER :
#ADVERTISER_NAME#
#BRAND_NAME#
#ADVERTISER_ADDRESS#
Account No:
#ADVERTISER_ID#
|
| DIVISION |
|
|
| |
| CUSTOMER ORDER NO. |
ISSUE DATE |
INSERTION START DATE |
FREQUENCY |
INSERTION NO. |
SALESPERSON |
PAGE NO. |
| #CUST_ORDER_NO# |
#ISSUE_DATE# |
#INSERT_START_DATE# |
#FREQUENCY# |
#INSERTION_NO# |
#SALESPERSON# |
#PAGE_NO# |
| DESCRIPTION |
AMOUNT |
| |
|
| VISA, MASTERCARD, AMERICAN EXPRESS ACCEPTED: (PLEASE PRINT) |
| Card #: |
| Exp Date: |
| Card Billing Address: Street: |
City: |
State: |
Zip: |
|
| Cardholder Name: |
| Signature: |
| |
|
WIRE PAYMENT ACCEPTED.
WIRE TO:
Bank of America - International Department, 1 Landmark Square, Stamford, CT 06901 USA
Swift Code: BOFAUS3N; ABA-026009593; Account #: 0001379437; Business Journals, Inc.
ACH/EFT #: 011900254; Account #: 0001379437; Business Journals, Inc. |
| |
IN U.S. DOLLARS $ |
|
|
|
| |
|
