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Payment method:
___ Check or Money Order Enclosed
(denominated in US dollars, payable to Image Express, Inc.)
___ VISA Card number __________________________
___ MasterCard Expiration date ______________________
___ American Express Name on card _________________________
Your e-mail address _________________________
Your phone number ___________________________
Your full postal address, _____________________________________
including street address,
city, state or province, _____________________________________
postal (ZIP) code, and
country. _____________________________________
Name of recipient:_____________________________________________
Recipient's full
Internet e-mail address:_______________________________________
On what date should we send
the e-mail announcment of your gift? __________________________
Who should we say this gift is from?
(this name will appear in the SUBJECT
line of the e-mail
announcement) _________________________________________________
(for additional gift subscriptions, use additional sheets)
If paying by check or money order, please mail this form
along with your payment of US $15 for each subscription ordered
to If paying by credit card, please mail to above address or fax to +1-530-660-5783. All gift subscription orders will be confirmed by e-mail within 2 business days of receipt.