Print this form and Mail or Fax to
Pacific Showcase - P. O. Box 41430
San Jose, CA 95160 - Fax: (408) 776-9811

Name: ___________________________________________________

Address: __________________________________________________

City: _____________________________________________________

State: _______  Zip: ___________________

Phone #: _____________________________

First Time Subscription         Renewal

Check or Circle the type of Subscription

1 Year
(U.S. ONLY)
2 Years
(U.S. ONLY)
Bulk Rate $25.00  $45.00 
First Class $35.00  $65.00 

Credit Card    Check

Credit Card Information
* We accept Discover, VISA and MasterCard

Card# ________________________________________   
Exp Date: ________________

Name on Card: ___________________________________________________________

Check # _____________________________

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Designed & Built by:
EDJE Technologies, LLC