FUNOMENA ON-LINE ORDER FORM

Date: NAME Last:   First: YOUR COMPLETE MAILING ADDRESS:   Phone: Fax: E-Mail: . #of items Funomena Magnet $2.00 Funomena Pin $2.00 Funomena Post Card $2.00 Funomena Comic Book (Limited Edition) $10.00 Funomena Game Live Exhibits lost in the USA $20.00 Funomena Coloring Book (Limited Edition) $10.00 Funomena T-Shirt (LARGE) $20.00 Funomena T-Shirt (EXTRA-LARGE) $20.00 Shipping and handling  $10.00 Total items Total cost   All prices include all applicable taxes. Minimum order $10.00 . PLEASE SELECT PREFERRED PAYMENT OPTION: You hereby unconditionally agree that Corporate Development Group of Companies or authorized representative thereof will debit your credit card for the amount and currency as indicated herein  in US dollars or equivalent thereof in Canadian funds as agreed in advance. By submitting your request you hereby unconditionally agree that your submission will be treated as your electronic signature on your credit card. VISA PLEASE ENTER YOUR VISA CREDIT CARD NUMBER BELOW: PLEASE ENTER THE EXPIRY DATE OF YOUR VISA CREDIT CARD (month and year): PLEASE ENTER VISA CARD HOLDER'S NAME AS IT APPEARS ON YOUR CREDIT CARD: Master Card PLEASE ENTER YOUR MASTER CARD NUMBER BELOW: PLEASE ENTER THE EXPIRY DATE OF YOUR MASTER CARD (month and year): PLEASE ENTER MASTER CARD HOLDER'S NAME AS IT APPEARS ON YOUR CREDIT CARD: . YOUR ORDER CONFIRMATION I, (please insert your  First and Last names in the space below) , hereby unconditionally agree that a click on the "SUBMIT" button below shall be acknowledge as an equivalent of my signature on my contract with Corporate Development Group of Companies (authorized sales agent of Funomena Products) which is a subject to approval by CDGC or authorized representative thereof. .. WE DO NOT ACCEPT THIRD PARTY CREDIT CARDS TO AVOID CREDIT CARD FRAUD PROBLEMS. Concerned about your privacy? You can save this file and send your order encrypted by using world's most secured encrypted web based mail free of charge. Go to  www.hushmail.com to learn more about this service or establish your own hushmail account..

E-MAIL: funomena@sk.sympatico.ca COPYRIGHT (C) Siwek Astral Travel This web site is developed and presently maintained by Corporate Development Group of Companies Please report any errors or problems by e-mail to cdci@sk.sympatico.ca