eMarketing Association
4259 Old Post Road - Charlestown, RI 02813

PHONE: 401.315.2194 FAX: 408.884.2461
REFERENCE # ADVEC-5 - INVOICE

Advanced eMail eCourse Invoice- $99.00
TOTAL AMOUNT DUE THIS INVOICE: $99.00

Please provide the following:

Date__________________

Member Name__________________________________________________________________

Address________________________________________________________________________

City______________________________________State_______________Zip_______________

Company:______________________________________________________________________

Company URL:__________________________________________________________________

Phone #:______________________________________ Ext.:____________________________

Email Address___________________________________Years of Marketing Experience: ______

Payment Method: Visa ___ MasterCard ___ American Express___ Check___

Card Number_____________________________________________Expiration ______________

If Different From Above:

Name On Card__________________________________________________________________

Address________________________________________________________________________

City______________________________________State_______________Zip_______________

Signature:______________________________________________________________________

Please indicate the month you would like to take the course_______________________