U.S. Land Company, Inc
---- Please Print And Fax Or Mail In ----
| Quantity |
Product/Event Name |
Price |
Shipping |
Total |
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$ |
$ |
$ |
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$ |
$ |
$ |
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$ |
$ |
$ |
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Total: |
$ |
Shipping Information (required for home study courses)
Name: _____________________________ Phone: _____________________
Email: _____________________________ Fax: ________________________
Shipping Address: ________________________________________________
City: ___________________ State: ________________ Zip: ______________
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Registration Information (required for live events)
Registrant’s Name: _______________________________________________
Guest’s Name (if applicable): _______________________________________
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Credit Card Payment:
Name On Card: _____________________ Card Type: ___________________
Credit Card Number: _____________________ Expiration: _______________
Billing Address: __________________________________________________
City: ___________________ State: ________________ Zip: ______________
Cardholder Signature: _____________________________________________
E-Check Payment:
Account Number: _________________________ Check Number: _________
Routing Number: _______________ Bank Name: _______________________
Mail-In Check Payment:
Please make check payable to: U.S. Land Company, Inc.
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| Mail Order Form To: |
OR |
Fax Order Form To: |
| U.S. Land Company, Inc |
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1-602-956-6604 |
| 8877 North 107th Ave, Ste 302-237 |
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| Peoria, AZ 85345 |
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Have Questions? Need help? Call us toll free at: 800-808-6349
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