NON-UK SUBSCRIPTION PAYMENT AUTHORITY

Simply print out and complete the Payment Form below and fax it to Mind Advertising Ltd at the address below.
FAX NUMBER (from outside the UK): +44 870 055 8992

SINGLE USER SUBSCRIPTION
 One Year Subscription £130 (UK Pounds) - OR -   One Month Subscription £25 (UK Pounds)

FIRST NAME:...............................................  SURNAME:.........................................................

TITLE:......................................................  COMPANY:.....................................................
ADDRESS..............................................................................................................................

.............................................................................................................................................

........................................................................................... POST/ZIP CODE.......................

DAYTIME TELEPHONE NUMBER.................................................................

E-MAIL ADDRESS.......................................................................................
username requested:....................................................................................
password:...................................................................................................

CREDIT CARD PAYMENT : Non-UK cardholders only
(UK cardholders will be issued with an electronic payment request via Paypal)
Please charge my MasterCard, Visa or Amex as specified above.

Credit Card Number................................................................................... Expiry date.......................... 

Credit Cardholder's Name.................................................................................(as printed on credit card)
Cardholder's House Number/Names............................ POST CODE/ZIP CODE of BILLING ADDRESS:............................
Enter only the number of the house as written in the street address. If the house does not have a number then enter the name of the house
Card Security Number.......................
For most cards this number appears on the back of the card at the top of the signature strip (3 digits).
On some other cards, including American Express there is a four-digit number on the front of the card just above the account number.