Please enclose a copy of this invoice with your payment.

eMarketing Association
224 Post Rd.4 #129
Westerly, RI 02891
PHONE: 401.315.2194 FAX: 408.884.2461
REFERENCE # eCM01 - INVOICE

1 eMA Site Certification-$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:______________________________________________________________________

Mail a copy of this invoice with your payment to the address above. or fax it to: 408.884.2461
You will receive an email confirmation of this order when payment is received.