Make a Payment

Company Name

Your First and Last Name (required)

Your Email (required)

Billing Address (required)

City (required)

State (required)

Select ...AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming

Billing Zip Code (required)

Phone (required)

Alternate Phone

Fax

Starting Month   SelectJanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember Starting Year Select20162017201820192020202120222023

Ending Month     SelectJanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecemberAuto Renew Ending Year  Select20152016201720182019202020212022Auto Renew

Please select the payment amount you are authorizing us to charge your credit card at the rate if $60 for a single issue or at the rate of 50 per month for 6 consecutive months: SelectAuto bill $50 per month with a 6 month contractAuto bill $75 per month with a 6 month contract for preferred placement$60.00, 1 issue$150.00, 3 issues$300.00, 6 issues$600.00, 12 issues$225.00, 3 issues, preferred placement$450.00, 6 issues, preferred placement$900.00, 12 issues, preferred placement

Credit Card (required)

SelectVISAMasterCardDiscoverAmerican Express

Account Number (required)

Expiration Date

Month (required) 010203040506070809101112 Year 15161718192021222324252627282930

CVV code (3 digit code on the back of the card if it's VISA, MasterCard or Discover or 4 digit code on the front of the card if it's American Express.):

Name of Cardholder

On behalf of my company or myself, I hereby reserve the coupon space(s) and issue date(s) indicated above and authorize South Lake Tahoe Coupons to charge the credit card indicated on this form.

I agree to accept full responsibility for any losses that might incur due to this publication.

The undersigned agrees to hold South Lake Tahoe Coupons harmless for any losses or liability that might occur due to this publication.

I understand that South Lake Tahoe Coupons does not make refunds.

I agree that my liability for this contract is not waived and I agree to be held personally liable in the event that the indicated person, company or association fails to pay any part or the full amount of these charges.

South Lake Tahoe Coupons Reserves the Right to Refuse Business to Anyone.

Auto renew this order until cancelledDo not auto renew

By checking this box I agree to the above terms and authorized the above charge to my credit card.

Artwork Upload

Link my coupon to this web address

Check this box if you do not have a website and would like to be contacted by our web development team.

Comments or special instructions:

Δ