To send your order via postal mail please print and mail the completed form to:
Mystik Media
296 Captain Beam Blvd
Hampstead, NC 28443
Product and Purchase Information:
Merchant Name: Mystik Media
Description: Blaze ImgConvert
Purchase amount: $29.95
Billing Address Information:
Name:_______________________________________________________________
Street (Line 1): ________________________________________________________
Street (Line 2): ________________________________________________________
City: ________________________________________________________________
State / Province: _______________________________________________________
ZIP / Post Code: _______________________________________________________
Country: _____________________________________________________________
Phone: ______________________________________________________________
E-mail: ______________________________________________________________
Payment Type
Select your type of Payment:
___Personal or business check. It usually takes 2 to 5 business days after receipt of the check for the bank to process the check. Once the check has been processed the activation code is e-mailed to you within 48 hours. (Attention: There is a $25.00 charge for all returned checks.)
___Cashier’s Check or Money Order
___Credit Card (Please ensure the address above matches the Credit Card’s business address.
Credit Card Information
If paying with a credit card please supply the following information:
Card Type: ____________________________________________________________
Card Number: _________________________________________________________
Expiration Date: ________________________________________________________
Signature: _____________________________________________________________
Thank You For Your Order!