subscription order form - aa · pdf filesubscription order form [ ] one year ... email: ......

Subscription Order Form [ ] One year (12 issues) $28.97 [ ] Two years (24 issues) $54.00 (Canada $35.00 US; Other $42.00 US) (Canada $65.00 US; Other $78.00 US) Number of copies: ______ * Name: _____________________________________________ Address: ___________________________________________ City, State, Zip: ______________________________________ Email: ______________________________________________ Payment method [ ] Check / Money Order US$________ [ ] Bill me [ ] VISA [ ] MasterCard Number: _______ - _______ - _______ - _______ Exp: _____ / _____ CVV/CID: _____ Signature: ___________________________________________ Mail to: Grapevine, PO Box 16867, North Hollywood, CA, 91615-6867 Phone: 800.631.6025 Fax: 818.487.4550 Online orders: www.aagrapevine.org 2-19 copies, 10% discount off the single copy price; 20-39 copies, 15%, 40 or more, 20%

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Subscription Order Form

[ ] One year (12 issues) $28.97 [ ] Two years (24 issues) $54.00 (Canada $35.00 US; Other $42.00 US) (Canada $65.00 US; Other $78.00 US)

Number of copies: ______ * Name: _____________________________________________ Address: ___________________________________________ City, State, Zip: ______________________________________ Email: ______________________________________________ Payment method [ ] Check / Money Order US$________ [ ] Bill me [ ] VISA [ ] MasterCard Number: _______ - _______ - _______ - _______ Exp: _____ / _____ CVV/CID: _____ Signature: ___________________________________________ Mail to: Grapevine, PO Box 16867, North Hollywood, CA, 91615-6867 Phone: 800.631.6025 Fax: 818.487.4550 Online orders: www.aagrapevine.org 2-19 copies, 10% discount off the single copy price; 20-39 copies, 15%, 40 or more, 20%

http://www.aagrapevine.org/

Page 2: Subscription Order Form - AA · PDF fileSubscription Order Form [ ] One year ... Email: ... Please attach this form to a Grapevine Multiple Subscription Form

Give a Gift Subscription

[ ] One year (12 issues) $28.97 [ ] Two years (24 issues) $54.00 (Canada $35.00 US; Other $42.00 US) (Canada $65.00 US; Other $78.00 US)

Gift for: ____________________________________________ Address: ___________________________________________ City, State, Zip: ______________________________________ My name: ___________________________________________ Address: ___________________________________________ City, State, Zip: ______________________________________ Email: ______________________________________________ Payment method [ ] Check / Money Order US$________ [ ] Bill me [ ] VISA [ ] MasterCard Number: _______ - _______ - _______ - _______ Exp: _____ / _____ CVV/CID: _____ Signature: ___________________________________________ Mail to: Grapevine, PO Box 16867, North Hollywood, CA, 91615-6867 Phone: 800.631.6025 Fax: 818.487.4550 Online orders: www.aagrapevine.org

http://www.aagrapevine.org/

Page 3: Subscription Order Form - AA · PDF fileSubscription Order Form [ ] One year ... Email: ... Please attach this form to a Grapevine Multiple Subscription Form

SINGLE PAYER’S INFORMATION COVER SHEET

FOR MULTIPLE GRAPEVINE SUBSCRIPTIONS

Please attach this form to a Grapevine Multiple Subscription Form Name: _____________________________________________ Address: ___________________________________________ City, State, Zip: ______________________________________ Email: ______________________________________________ Payment method [ ] Check / Money Order US$________ [ ] VISA [ ] MasterCard Number: _______ - _______ - _______ - _______ Exp: _____ / _____ CVV/CID: _____ Signature: ___________________________________________ Mail to: Grapevine, PO Box 16867, North Hollywood, CA, 91615-6867 Phone: 800.631.6025 Fax: 818.487.4550