WESTERN MATCH.COM P.O. Box 677 Cave Creek, AZ 85327-0677 INSTANT MONEY ORDER FAX FORM Please fill out the form completely. Sign and date it on the bottom. Send this copy along with your money order.
Your Name: ____________________________________ (Please print clearly) Your Email Address: _____________________________ Your Address: __________________________________ City, State & Zip code ____________________________ Your Username: _________________________________	Membership Amount: (Please place a check mark next to the membership amount you are sending.) ____ $14.95 One Month Membership ____ $19.95 Three Month Membership ____ $28.95 Six Month Membership ____ $39.95 One Year Membership
Terms of Service:You agree to pay Western Match.com in the form of a money order, in the amount specified on this form, for an upgraded membership. By faxing this form, you are confirming that you have purchased a money order, and are faxing proof of purchase to Western Match.com. You agree that you will send the original money order to Western Match.com within (3) three business days. You understand if the money order is not received within (7) seven days, your upgraded membership will be suspended until the money order is received.
Your Signature: ___________________________________________, if sending a fax. Date: .____________________