Our Maine Street's Aroostook Issue 23 : Winter 2015 | Page 6

Our Maine Street LLC 48 Presque Isle Street, Fort Fairfield, ME 04742 www.ourmainestreet.com 207.472.3464 I want a subscription for myself! Your Name:________________________________________________________________________ Address:__________________________________________________________________________ Address:__________________________________________________________________________ City / Town:________________________State:____________________________Zip:____________ Phone:________________________________Email:______________________________________ Pay by Check: Please include a check for $25 made payable for Our Maine Street LLC. 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 $25 per additional subscription) Your Friendʼs Name:_________________________________________________________________ Address:__________________________________________________________________________ Address:__________________________________________________________________________ City / Town:________________________State:____________________________Zip:____________ Phone:________________________________Email:______________________________________ Your Friendʼs Name:_________________________________________________________________ Address:__________________________________________________________________________ Address:__________________________________________________________________________ City / Town:________________________State:____________________________Zip:____________ Phone:________________________________Email:______________________________________ Your subscription(s) will begin with the next issue. Our Maine Street will only use this information to fulfill your subscription request and keep you updated as a subscriber. This form will be destroyed after payment is complete to protect your credit card information. The USPS will not forward magazines. If you are a Snowbird, please contact us and we will gladly do seasonal change of address. Please note that itʼs your responsibility to inform us of any changes to your address. We will not be responsible for any re-mailings.