Our Maine Street's Aroostook Issue 2 : Fall 2010 | Page 20

Our Maine Street M a g a z i n e 232 Main Street Suite 2, Fort Fairfield, ME 04742 www.ourmainestreet.com 207.472.3464 An Excellent Christmas Gift! I want a subscription for myself! Your Name:________________________________________________________________________ Address:__________________________________________________________________________ Address:__________________________________________________________________________ City / Town:________________________State:____________________________Zip:____________ Phone:________________________________Email:______________________________________ Pay by Check: Please include a check for $24 made payable for Our Maine Street. please circle: Credit Card Number:_______________________________________________ 3-Digit CCID Code:______________________________(on back right of card) Expiration Date:___________________________________________________ Name on card:___________________________________________________ Authorized Signature:______________________________________________ I want to give a gift subscription! (add $24 per additional subscription) Your Friend’s Name:_________________________________________________________________ Address:__________________________________________________________________________ Address:__________________________________________________________________________ City / Town:________________________State:____________________________Zip:____________ Phone:________________________________Email:______________________________________ Your Friend’s Name:_________________________________________________________________ Address:__________________________________________________________________________ Address:__________________________________________________________________________ City / Town:________________________State:____________________________Zip:____________ Phone:________________________________Email:______________________________________ Your subscription(s) will begin with the next issue (January 2010). Our Maine Street will only use this information to fulfill your subscription request and keep you updated as a subscriber. Should we be unable to complete your request for any reason, funds for undelivered issues will be refunded. This form will be destroyed after payment is complete to protect your credit card information. 18 FALL & WINTER 09