Magazines on Barter Order form

Date:

-- mm/dd/yy

Please provide the following information:

Name
Company
Street Address
Address (cont.)
City
State
Zip Code
Phone
FAX
E-mail

Will all subscriptions go to the above address?

Yes
No

If not, please enter alternate subscription name and address:

Name
Subscriptions

to go to this address 

Street Address
Address (cont.)
City
State
Zip Code

Your order:

Magazine Title
SKU #
Barter price X number of years  

Magazine Title
SKU #
Barter price X number of years  

Magazine Title
SKU #
Barter price X number of years  

Magazine Title
SKU #
Barter price X number of years  

Magazine Title
SKU #
Barter price  X number of years  

Order Total:

 

Florida Barter Account Name:

 

Florida Barter Account Number:

 

I agree to the Magazines on Barter terms and Guidelines:

Yes
No

When you click on the "Submit Form" button below, an email will be sent to Florida Barter with your order.