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2007-08 Membership & Redemption Form |
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Please Fax to 631-369-3507 |
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| Or mail to | |||
| Eyre Designs | |||
| 233 River Road | |||
| Manorville, NY 11949 | |||
| Member Number ______ (if Renewal) | |||
| Club Member Name _____________________________ | |||
| Club Member Address ____________________________________________ | |||
| City _________________ State ______________ Zip __________________ | |||
| Daytime Phone #___________________ Evening Phone # __________________ | |||
| Email Address _________________________ | |||
| Eyre Designs Message Board ID Name :____________________ (For those on the | |||
| message board, this will help us retain your message board membership privileges) | |||
| Dealer Name: _________________________________ if applicable | |||
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___ Tickle my Fancy -- Membership Orange and Ivory for $55.00 |
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| Payment Method | |||
| Visa, Master Card (sorry we do not accept Amex or Discover any longer) | |||
| Card Number _________________________________ | |||
| Expiration Date : ____________ | |||
| Name on card: _________________________________ | |||
| Card Holder Signature _____________________ this authorizes the charge to your card. | |||
| Billing address of card if different from above Membership address:____________ | |||
| _____________________________________________________________________ | |||
