This form may be submitted, faxed or mailed.   Please print a copy of this form
to submit with mailed-in payments.

If you have any questions or wish to place your order over the phone, please call our office at: 631-661-2727 during regular business hours (EST M-F).

Please provide the following delivery information (Note: This portion of the form is used for delivery and contact information. If you will be paying by credit card, you will also be asked to enter your name and address as it appears on your credit card bill.

Name
Title
Company
Street address
Address (cont.)
City
State/Province
Zip/Postal code
Country
Phone
Fax
E-mail
Delivery Method	Email to Email Address Above CD-ROM to Address Above
Method of Payment (If paying by credit card, please  complete the next five boxes.)	Sending Check by Mail American Express Master Card Visa
Credit Card Number
Expiration Date	Month: 01 02 03 04 05 06 07 08 09 10 11 12 Year: 2013 2014 2015 2016 2017 2018 2019
Card Security Code*
Name as it Appears on Credit Card
Credit Card  Billing Address
Credit Card  City, State Zip

* The security code is a "extra" number that accompanies your credit card.
On Visa & Master Card, the number is the last three digits from  the back of the card as it appears on/near the signature strip. On American Express cards, the number appears above and to the right of the regular card number on the front of the card. 

NOTE: To place your credit card order NOW, 
click the "Submit Button" below.

If paying by check, please make checks payable to "SPC Marketing Company" and return along with a copy of this form to:

SPC MARKETING COMPANY
P.O. Box 221
Brightwaters, NY 11718
Phone: 631-661-2727
Fax: 631-883-7360
E-Mail