Subscription Form
Use this form to purchase a one-year e-mail subscription to The Daily Motivator. This form is designed to be printed, filled in by hand, and sent by postal mail with your payment (check, money order, VISA, MasterCard or American Express.) As soon as your payment arrives, you'll receive a confirmation by e-mail, and your subscription will begin the next day. If you prefer to place your order online using your credit card, please go to the secure order/payment form.
Print out this form and then fill in the information below. Please PRINT CAREFULLY AND CLEARLY!
Name _________________________________________________________________
E-mail address at which
you wish to receive
The Daily Motivator __________________________________________________
Phone number (optional, but recommended) _____________________________
Payment method: __ Check enclosed for $15.00 (US Dollars ONLY)
payable to Image Express, Inc.
__ Money order enclosed for $15.00 (US Dollars ONLY)
payable to Image Express, Inc.
__ VISA __ MasterCard __ American Express
For credit card orders, please fill in the following
Card number ________________________________________
Expiration date (month & year) _____________________
Print your name as
it appears on card _________________________________
Your mailing
address ________________________________________
Signature __________________________________________
Mail this completed form along with your payment to:
Image Express, Inc.
P.O. Box 66536
Austin, TX 78766
USA
Return to The Daily Motivator top page