Order Form

Wedding Name Change Kit - MAIL IN ORDER FORM

You may print and use this form to send in a payment by mail. Please make checks payable to:

APC Entertainment Network, LLC - POB 110120 - Nutley, NJ 07110

ORDER INFORMATION:

Qty: 1 Miss Now Mrs Name Change Service $29.95 + $2.00 for shipping/handling= $31.95

SHIPPING INFORMATION:

Name: _______________________________________________________________________

Address: _____________________________________________________________________

City: ________________________________ State: _______ Zip: _______________________

Daytime phone number: __________________________

Email: _________________________________________

Which state would you like your kit specified for? _________________

Have you gotten married yet? _____Yes _____Not yet

All sales are final. We do not accept returns.

Thank you and congratulations!

Phone Inquiries & Orders: 973-320-2279

FORM 0406NC