Company _______________________________________

BCC Customer #_________________________________

Address ________________________________________

City________________State______ZIP + 4_____________

Phone (_____)_______________ FAX (____)___________

 Standard Mail Manager 2010     Advanced Mail Manager 2010

Training Dates Desired _____________________________

# Attending __________________ Total Cost ___________

Names of Attendees:
________________________    _____________________
________________________    _____________________

Emails of Attendees:
________________________    _____________________
________________________    _____________________

Method of Payment:         Check            Money Order

   Invoice _____________________(PO# required)

    Amex        MasterCard        Visa          Discover

16 Digit Account Number

  __  __  __  __  __  __  __  __  __  __  __  __  __  __  __  __

Expiration Date:   Month  __  __     Year __  __

Cardholder's Name _______________________________

Cardholder's Signature ____________________________
                                                                      (necessary for processing)

What is the number one reason you are attending training?

____________________________________________________________
____________________________________________________________