FAX ORDER FORM

For those who prefer not to use online credit card ordering, you have a few options:
  • Print and fax this order form with your credit card number and signature to: 208-247-2312
  • Print and mail this to us with your check or money order to:
    Now Intermedia Inc, PO Box 420856, Summerland Key, FL 33042

Note: Your order will be processed once the credit card transaction or your check clears. Now Intermedia Inc is the owner of 1second.com.

Your login name: _____________________

* If you don't have your login name, please register first at:
http://www.1second.com
Registration is free and doesn't require credit card information.

Billing Information:
Name: _________________________________
Address: _________________________________
City: _________________________________
State: _________________________________
ZIP: _________________________________
Telephone: _________________________________
Fax: _________________________________
E-mail: _________________________________

Credit Card Info

Visa [ ]   MasterCard [ ]

Credit Card #: _____________________   Exp.Date: ___________

I, the credit card holder, authorize Now Intermedia Inc., to charge my credit card for the below-noted amount of (US Dollars) $.

Signature: _____________________

Total amount US$: ____________

Comments (if any): _______________________________________________________

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