CHANGE Order Form.  Do a simple print screen to obtain paper form for your use.

OFFICIALLY WISCONSIN(sm) - Internet Advertising Change Order Form
                                       Mail or fax to:
                                       Officially Wisconsin - Sales Dept
                                       2425 N. 95th St - Suite 200
                                       Wauwatosa, WI  53226
                                       Voice/Fax: (800) 330-9867       

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Name: __________________________________________________

Company: _______________________________________________

Mailing Address: 

______________________________________  

______________________________________  

City: _______________________ State: _____  Zip: ________

Phone #: (____)_____________________

E-mail address: ____________________

          
Existing ad to be changed? (Short description, which communities, Yellow Pages
classification(s), etc.)

______________________________________________________________________________


Describe changes you want made.  Be specific.

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

Yes, I understand there is a flat $15.00 charge for these (same ad) changes. 
I realize this fee is only for processing the change, and does not extend my advertising subscription.

____ I have enclosed check for $15.00

____ I am faxing advertisement change.  Credit card information below:

     Credit card # _______________________  __ Master Card   __ VISA     
                                
     Expiration date: ____________

     Cardholder name: ____________________
                     (Please print)
 

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