| Make check payable to:
Modern Communication
Assistance (MCA)
|
* Invoice
#: _____________________________ |
| * (Invoice # to be assigned by
MCA) |
| PO Box 184 |
Date:
_____________________________ |
| Macon, Mo 63552 |
For directory listing in: |
|
http://www.maconinformation.com |
| Customer Information: |
|
| Name:____________________________________________ |
Phone:
________________________ |
| List as:
___________________________________________ |
| Address:__________________________________________ |
Fax:
__________________________ |
| City:
_______________State: _____Zip:_________________ |
http://www._____________________ |
| Email:__________________________ |
| Contact Name:____________________________________________ |
|
| Directory
Location: |
|
| List in
Section:___________________________________________ |
2nd
Section:_____________________ |
| Pricing: |
Method of
Payment: |
| Number of
Listings:______ @ $40.00 = ___________________ |
Cash:$________________________ |
| Number of
Listings:______@ $65.00 = ___________________ |
Check:#________________________ |
| Total Billed
$_______________________________________ |
Total Paid:
_____________________ |
