Michael Scott Money Order Form

Michael-Scott.Com Mail Order Form

Please complete the following fields and mail this form with payment to the address below

Name:

Address:

City/State/Zip:

Country:

Telephone Number:

Birth Date:

Email Address:

Username:

Password:

Membership Type:

Package #1 - Michael-Scott.Com - $29.95

Package #2 - 3 Month Membership - $89.95

Package #3 - 6 Month Membership - $109.95

Package #4 - 12 Month Membership - $119.95

Signature:

Please note by completing and signing this form you are verifying that you are 18 years or older.

Mail completed form along with Money Order to:

The Michael Scott Company
PO BOX 683
Lewis Center, Ohio 43035