Online Survey Cash

MAIL ORDER FORM

Please print this form, enter the required information and mail to:

Austin Research Institute
Dept # OSC
P.O. Box 922
Hampstead, MD 21074
USA



COST FOR MEMBERSHIP

  The cost for complete access to the Online Survey Cash member's area is just $39.99.
  This is a one-time cost.



PAYMENT OPTIONS

  We accept the following forms of payment (U.S. funds only):

  Note: We do not accept personal checks or COD's. Maryland residents add 5% sales tax.


  Please make your money order payable to: Austin Research Institute


CUSTOMER INFORMATION


  NAME: ____________________________________________________

  EMAIL ADDRESS: ____________________________________________

  EMAIL ADDRESS (REPEAT): ____________________________________




AGE VERIFICATION

  I hereby certify that I am at least 18 years of age.

  CUSTOMER SIGNATURE: ____________________________________________



Mail this completed form (with payment) to:

Austin Research Institute
Dept # OSC
P.O. Box 922
Hampstead, MD 21074
USA

Your username and password will be e-mailed to you immediately upon receipt of payment. Thank you.


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