ORDER FORM

Please print this page and fill out completely and mail to the address below to order your Grocery Coupon Certificate Book

For faster service, PLEASE print/write neatly. All checks MUST clear before your Coupon Certificate Book will be mailed. In the event your check DOES NOT clear, you will be notified and your name will be placed on a list and we will NOT be able to accept a check from you. If you wish to purchase a Coupon Certificate Book, you will have to pay by money order only. Only US checks/money orders will be accepted. We hope you understand and respect this policy

Make checks/money orders payable to MB Express and mail to:
MB Express
P.O. Box 42242
Indianapolis, IN 46242


Please indicate which quantity you are purchasing:
( )1 Book for 15.00
( )2 Books for 26.00


PLEASE fill out the following information neatly for faster service:

NAME:_____________________________

ADDRESS:______________________________

CITY/STATE/ZIP:______________________________

AMOUNT OF CHECK/MONEY ORDER:_______________

***Please allow 4-6 weeks for delivery.



1102